Srpski Arhiv za Celokupno Lekarstvo (Jan 2011)
Do we reach target lipid levels in diabetic and non-diabetic patients with previous myocardial infarction?
Abstract
Introduction. Considering that dyslipidaemia is an important factor for cardiovascular diseases, target lipid levels are rarely reached in everyday clinical practice. Objective. The objective of this study was to evaluate how often we achieve the treatment goals for the lipid parameters in the diabetic and non-diabetic patients after the previous myocardial infarction (MI). Methods. The survey included 118 patients (84 males and 34 females), mean age 59.38±9.86 years, 34 (28.8%) of them diabetics, with the history of MI in the previous 3 years. The patients were selected from the database of multicentre prospective interventional study “Secondary prevention of coronary heart disease and cerebrovascular diseases”, conducted in 2005 on 1,189 patients in Serbia. The patients were further followed in the period from 18 (5th visit) and 36 months (6th visit) after inclusion into the study from 2005-2008. Their lipid status, the use of lipid-lowering drugs, and the independent prognostic factors for major adverse coronary events were identified. In the beginning of the study, all patients were informed about the importance of lifestyle change and active approach to treatment. The accomplishment of secondary preventive measures was estimated on the basis of the European guidelines on secondary prevention of the coronary heart disease. Results. Three years after introduction of the preventive measures, diabetics had a higher prevalence of the target levels of the total cholesterol (21.2% vs. 7.6%) and HDL-cholesterol than non-diabetics (100% vs. 87.3%) (p<0.05). Non-diabetics had significantly higher prevalence of the target levels of LDL-cholesterol than diabetics (19% vs. 3%) (p<0.05). No significant differences were found in the prevalence of the treatment goals of triglycerides in diabetic (42.4%) and non-diabetic patients (60.8%) (p>0.05). At the end of the study, after applying secondary prevention measures, 27.3% of diabetics did not use lipid-lowering drugs. The percentage of non-diabetics using no lipid-lowering drugs was lower (20.3%), but the difference was not statistically significant (p>0.05). By using the method Enter Cox regression multivariant analysis, the change in the level of triglycerides, total and LDL-cholesterol were singled out as independent prognostic factors for major adverse coronary events. Conclusion. Our study has shown high prevalence of increased plasma concentrations in the total, LDL-cholesterol and triglycerides and low plasma concentrations of HDL-cholesterol, as well as the insufficient use of lipid-lowering drugs in diabetic and non-diabetic patients with previous MI. Decreasing the total cholesterol and increasing the HDL-cholesterol are significant, decreasing of triglycerides and LDL-cholesterol does not suffice. Therefore, secondary prevention measures of cardiovascular events should be intensified, especially in patients with diabetes.
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