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Low-density lipoprotein cholesterol treatment and outcomes in patients with type 2 diabetes and established cardiovascular disease: Insights from TECOS.

Publication ,  Journal Article
De Ferrari, GM; Stevens, SR; Ambrosio, G; Leonardi, S; Armstrong, PW; Green, JB; Wamil, M; Holman, RR; Peterson, ED; TECOS Study Group,
Published in: Am Heart J
February 2020

BACKGROUND: Type 2 diabetes (T2D) patients are at increased risk for cardiovascular (CV) events. Most guidelines recommend treating low-density lipoprotein cholesterol (LDL-C) levels to ≤70 mg/dL (1.8 mM) for patients with T2D and established atherosclerotic CV disease, and some a more aggressive target of ≤55 mg/dL (1.4 mM). Our objective was to assess the degree to which these LDL-C targets are achieved in routine practice. METHODS: Using data from TECOS, an international pragmatic CV outcomes trial of sitagliptin vs placebo, we assessed lipid-lowering treatment among patients with T2D and CV disease, baseline lipid values, and the association between baseline LDL-C and 5-year risk for major adverse cardiac events (MACE; ie, CV death, nonfatal myocardial infarction, or nonfatal stroke). RESULTS: Overall, 11,066 of 14,671 TECOS participants (75.4%) had LDL-C measured at baseline. Median age was 65 years, 72% were male, and median T2D duration was 10 years. Overall, 82.5% of patients were on statins; only 5.8% were on ezetimibe. At baseline, 14.3% had LDL-C ≤55 mg/dL, 18.4% between 55.1 and 70 mg/dL, 35% between 70.1 and 100 mg/dL, and 32.3% >100 mg/dL. Each 10 mg/dL higher LDL-C value was associated with a higher risk of MACE (HR 1.05, 95% CI 1.03-1.07) or CV death (HR 1.06, 95% CI 1.04-1.09). CONCLUSIONS: Although most high-risk patients with T2D and CV disease were on lipid-lowering therapy, only 1:3 had LDL-C <70 mg/dL and 1:6 had LDL-C <55 mg/dL. Each 10 mg/dL higher LDL-C value was associated with a 5% and 6% higher 5-year incidence of MACE and CV death, respectively. (TECOS, NCT00790205).

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2020

Volume

220

Start / End Page

82 / 88

Location

United States

Related Subject Headings

  • Stroke
  • Sitagliptin Phosphate
  • Reference Values
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Hypoglycemic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Female
 

Citation

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Chicago
ICMJE
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De Ferrari, G. M., Stevens, S. R., Ambrosio, G., Leonardi, S., Armstrong, P. W., Green, J. B., … TECOS Study Group, . (2020). Low-density lipoprotein cholesterol treatment and outcomes in patients with type 2 diabetes and established cardiovascular disease: Insights from TECOS. Am Heart J, 220, 82–88. https://doi.org/10.1016/j.ahj.2019.11.005
De Ferrari, Gaetano M., Susanna R. Stevens, Giuseppe Ambrosio, Sergio Leonardi, Paul W. Armstrong, Jennifer B. Green, Malgorzata Wamil, Rury R. Holman, Eric D. Peterson, and Eric D. TECOS Study Group. “Low-density lipoprotein cholesterol treatment and outcomes in patients with type 2 diabetes and established cardiovascular disease: Insights from TECOS.Am Heart J 220 (February 2020): 82–88. https://doi.org/10.1016/j.ahj.2019.11.005.
De Ferrari GM, Stevens SR, Ambrosio G, Leonardi S, Armstrong PW, Green JB, et al. Low-density lipoprotein cholesterol treatment and outcomes in patients with type 2 diabetes and established cardiovascular disease: Insights from TECOS. Am Heart J. 2020 Feb;220:82–8.
De Ferrari, Gaetano M., et al. “Low-density lipoprotein cholesterol treatment and outcomes in patients with type 2 diabetes and established cardiovascular disease: Insights from TECOS.Am Heart J, vol. 220, Feb. 2020, pp. 82–88. Pubmed, doi:10.1016/j.ahj.2019.11.005.
De Ferrari GM, Stevens SR, Ambrosio G, Leonardi S, Armstrong PW, Green JB, Wamil M, Holman RR, Peterson ED, TECOS Study Group. Low-density lipoprotein cholesterol treatment and outcomes in patients with type 2 diabetes and established cardiovascular disease: Insights from TECOS. Am Heart J. 2020 Feb;220:82–88.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2020

Volume

220

Start / End Page

82 / 88

Location

United States

Related Subject Headings

  • Stroke
  • Sitagliptin Phosphate
  • Reference Values
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Hypoglycemic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Female