Singeisen, Hélène; Renström, Frida; Laimer, Markus; Lehmann, Roger; Bilz, Stefan; Brändle, Michael (2023). An estimation of the consequences of reinforcing the 2016 and 2019 ESC/EAS guidelines on current lipid-lowering treatment in patients with type 2 diabetes in tertiary care - a SwissDiab study. European journal of preventive cardiology, 30(14), pp. 1473-1481. SAGE Publications 10.1093/eurjpc/zwad178
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BACKGROUND
In 2019, the ESC/EAS updated the 2016 guidelines for the management of dyslipidaemias recommending more stringent LDL-cholesterol (LDL-C) targets in diabetes mellitus type 2 (DM2). Based on a real-world patient population, this study aimed to determine the feasibility and cost of attaining guideline-recommended LDL-C targets, and assess cardiovascular benefit.
METHODS
The Swiss Diabetes Registry is a multicentre longitudinal observational study of outpatients in tertiary diabetes care. Patients with DM2 and a visit 01.01.2018-31.08.2019 that failed the 2016 LDL-C target were identified. The theoretical intensification of current lipid-lowering medication needed to reach the 2016 and 2019 LDL-C target was determined and the cost thereof extrapolated. The expected number of MACE prevented by treatment intensification was estimated.
RESULTS
294 patients (74.8%) failed the 2016 LDL-C target. The percentage of patients that theoretically achieved the 2016 and 2019 target with the indicated treatment modifications were: high-intensity statin, 21.4% and 13.3%; ezetimibe, 46.6% and 27.9%; PCSK9 inhibitor (PCSK9i), 30.6% and 53.7%; ezetimibe and PCSK9i, 1.0% and 3.1%, whereas one (0.3%) and five patients (1.7%) failed to reach target, respectively. Achieving the 2016 versus 2019 target would reduce the estimated 4-year MACE from 24.9 to 18.6 versus 17.4 events, at an additional annual cost of medication of 2,140 CHF versus 3,681 CHF per patient, respectively.
CONCLUSIONS
For 68% of the patients, intensifying statin treatment and/or adding ezetimibe would be sufficient to reach the 2016 target, whereas 57% would require cost-intensive PCSK9i therapy to reach the 2019 target, with limited additional medium-term cardiovascular benefit.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition |
UniBE Contributor: |
Laimer, Markus |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2047-4873 |
Publisher: |
SAGE Publications |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
25 May 2023 15:09 |
Last Modified: |
11 Oct 2023 00:12 |
Publisher DOI: |
10.1093/eurjpc/zwad178 |
PubMed ID: |
37226890 |
Uncontrolled Keywords: |
Diabetes mellitus type 2 ESC/EAS guideline LDL-cholesterol PCSK9 inhibitor ezetimibe statin treatment target |
BORIS DOI: |
10.48350/182919 |
URI: |
https://boris.unibe.ch/id/eprint/182919 |
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