Low-density Lipoprotein Cholesterol Control Research Articles

Impact of SCORE2 on cardiovascular risk reclassification and prevalence of LDL-cholesterol control according to most recent equations in a wide hypertensive population

Background and Aims : Recently, an updated cardiovascular risk (CVR) model (SCORE2) and several apparently more accurate equations than Friedewald to calculate low-density lipoprotein cholesterol (LDLc) have been proposed and validated. Our work aimed to evaluate the impact of both SCORE2 on CVR stratification and of new formulas on prevalence of LDLc control in a wide hypertensive population.

Impact of a virtual lipid clinic on lipid-lowering therapy, LDL cholesterol levels, and outcomes in patients with acute coronary syndrome

Atherosclerotic cardiovascular disease is a very common condition in routine practice and a leading cause of morbidity and mortality all around the world. To determine the impact of a strategy based on strict control and close follow-up for patients with acute coronary syndrome (ACS) through the use of "post-ACS virtual lipid visits" on lipid-lowering therapy, low-density lipoprotein cholesterol (LDL-c), and outcomes. Prospective study that consecutively included patients with ACS during 2020. All patients were discharged with high-intensity statins, and the lipid profile was determined after 1 month. At this time, patients were contacted by phone, and treatment was adjusted following the therapeutic algorithm of the Spanish Society of Cardiology. These visits were repeated every month until LDL-c reached <55 mg/dL. Patients were then transferred to scheduled conventional outpatient visits. A total of 346 patients (67.3±2.3 years; 68.2% men) were included. Follow-up was 12-24 months (mean, 17.7±3.8; median, 17.3). Definitive lipid-lowering therapy (mean uptitration time, 3.2±2.1 months) consisted of high-intensity statins alone (32.4%), high-intensity statins plus ezetimibe (56.9%), and PCSK9 inhibitors (10.7%). LDL-c decreased from 108.4±40.6 to 48.7±14.4 mg/dL. At baseline, LDL-c was <100 mg/dL, 70 mg/dL, and 55 mg/dL in 44.5%, 17.6%, and 7.2% of patients, respectively. At study end, these percentages were 100%, 95.4%, and 81.5%, respectively. After one year of follow-up, 3-P MACE, 4-P MACE, and cardiovascular mortality were recorded in 3.5%, 4.0% and 1.5% of patients, respectively. At study end, these percentages were 4.0%, 5.2%, and 1.7%, respectively. The implementation of a post-ACS virtual lipid visit model led to early optimization of lipid-lowering therapy, which led to marked improvements in LDL-c control rates and low MACE and mortality rates.

ROSuvastatin and Amlodipine as free or fixed combination on theRApeutic taRgets and treatment Adherence in hypertensive, hypercholesterolemic individuals. ROSA RARA: a spontaneous, observational study conducted by italian outpatient cardiologists

Background: Hypertension and LDL hypercholesterolemia often coexist, and their effective treatment has favorable implications for cardiovascular health. We aimed at defining the impact of amlodipine and rosuvastatin as free or fixed combinations on blood pressure (BP) and LDL-cholesterol, and the satisfaction with treatment, in hypertensive individuals with LDL hypercholesterolemia. Methods: A spontaneous longitudinal observational study was conducted at Italian cardiology outpatients clinics. Eligible individuals (age ≥ 18y, informed consent, stable 5 or 10 mg amlodipine therapy in addition to a RAAS inhibitor, stable 10 or 20 mg rosuvastatin therapy) underwent home and office BP and LDL-cholesterol assessment at 12 and 24 weeks. BP and LDL-cholesterol control rates and satisfaction with the fixed combination were assessed. Results: 285 participants were enrolled (51%M; 67 ± 10y; 94 on the free combination). At 12 weeks, mean BP and LDL-cholesterol were reduced in both groups, with higher hypertension control rates in the fixed combination group; at 24 weeks they were further reduced compared with baseline, and home systolic BP was lower in the fixed than the free combination group (121.9 ± 17.6 vs 129.4 ± 8.5 mmHg; p = 0.03). Patients in the fixed combination reported higher satisfaction with this regimen than with the free combination. Conclusions: The fixed combination of calcium channel blocker and statin appears to have advantages in terms of clinical efficacy and patients’ satisfaction.

Patients with comorbid coronary artery disease and hypertension: a cross-sectional study with data from the NHANES.

BackgroundHypertension (HTN) and coronary artery disease (CAD), two common cardiovascular diseases, are often comorbid and interacted. The patients with comorbid CAD and HTN have worse outcomes and prognosis, however, the prevalence remains unclear. In the cross-sectional study, we aimed to explore the prevalence and influence factors of patients with comorbid CAD and HTN in the USA.MethodsAdult patients with comorbid CAD and HTN derived from the National Health and Nutrition Examination Survey (NHANES) database in the 1999–2000 and 2017–2018 cycles were included. Demographic data, physical examination results, laboratory data, and questionnaire data were collected and compared in the two cycles. Subgroup analyses were performed between the elder (≥65 years of age) and middle-young (18–65 years of age) populations.ResultsThe age-adjusted prevalence of patients with comorbid CAD and HTN increased from 4.22% [1999–2000] to 5.40% [2017–2018] (P=0.006) and the age decreased from 71 [63–79] to 69 [61–77] years (P=0.008). The HTN control rate, the low-density lipoprotein cholesterol (LDL-C) control rate, systolic blood pressure (SBP), and the levels of blood lipids, as well as the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and statins improved in the 2017–2018 cycle as compared with the 1999–2000 (all P<0.05). On the other hand, the proportions complicated with diabetes mellitus (DM), obesity and chronic kidney disease (CKD), as well as the levels of serum glucose, glycohemoglobin and creatinine increased from the 1999–2000 to 2017–2018 (all P<0.01). Subgroup analyses revealed that the prevalence of middle-young patients with comorbid CAD and HTN increased more than their elder counterparts, while diastolic blood pressure (DBP), pulse, blood lipids and oral medication rates were inferior to the latter.ConclusionsThe recent prevalence of patients with comorbid CAD and HTN increased than 20 years ago, mainly caused by more morbid middle-young population. For another, the control of blood pressure (BP) and lipids were favorably affected by increased use of statins, ACEIs/ARBs and β-blockers in these patients. Nevertheless, there is still much room for strengthening medication utilization and intervention of risk factors in future.

A Randomized Study to Evaluate the Effect of an Inclisiran First Implementation Strategy vs Usual Care in Patients with ASCVD and Elevated Low-density Lipoprotein Cholesterol: Rationale and Design of the VICTORION-INITIATE Trial

Lead Author's Financial Disclosures Nothing to disclose. Study Funding Novartis Pharmaceuticals Corporation, East Hanover, NJ. Background/Synopsis Most patients with atherosclerotic cardiovascular disease (ASCVD) have elevated low-density lipoprotein cholesterol (LDL-C). Compared to placebo, inclisiran has been shown to be safe, tolerable, and effective at reducing LDL-C in patients with ASCVD. It is unknown whether an inclisiran first strategy compared to usual care (allowing for changes in lipid-lowering therapy to mimic routine clinical decision-making) can improve LDL-C control in patients with ASCVD when inclisiran is added to statin therapy. Objective/Purpose Describe the rationale and design of the ongoing VICTORION-INITIATE (NCT04929249) trial. Methods VICTORION-INITIATE is a phase 3, randomized, 2-arm, parallel-group, open-label, U.S.-based trial assessing the efficacy of an inclisiran first strategy vs usual care to treat ASCVD. Patients in the inclisiran arm will receive both inclisiran and maximally tolerated statin therapy immediately upon failure to reach LDL-C less than 70 mg/dL with statins alone. Patients in the usual care arm will continue to receive maximally tolerated statin therapy and may receive other non-statin therapies per usual care. Sites were selected based on geography, population, and lipid management practices. The trial will enroll ∼444 patients (aged greater than or equal to 18 years) with established ASCVD and elevated LDL-C (greater than or equal to 70 mg/dL) or non-high-density lipoprotein cholesterol (greater than or equal to 100 mg/dL) despite receiving maximally tolerated statin therapy, fasting triglycerides less than 500 mg/dL, and an estimated glomerular filtration rate greater than 30 mL/min. The study has 6 planned visits over 330 days from screening to completion. Results Primary outcomes are percent change from baseline in LDL-C and proportion of patients discontinuing statins during the 330-day trial. Key secondary outcomes include the proportion of patients achieving prespecified LDL-C targets, proportion of patients achieving greater than or equal to 50% LDL-C reductions, absolute and time-averaged changes in LDL-C, changes in other lipids, changes in and adherence to ongoing lipid-lowering therapy, visit-to-visit variability in LDL-C, and inclisiran safety and tolerability. Conclusions VICTORION-INITIATE is ongoing and planned to complete in early 2023. This trial aims to determine the efficacy of adding inclisiran first when maximally tolerated statin therapy fails to achieve LDL-C less than 70 mg/dL in those with ASCVD. Nothing to disclose.

EE217 Lost Therapeutic Benefit of Delayed LDL-C Control and Cost-Effectiveness Analysis of Lipid-Lowering Intensification

Attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in statin-treated patients remains suboptimal. We quantified the health and economic impact of achieving LDL-C control at different time points.

Sex Difference in Control of Low-Density Lipoprotein Cholesterol in Older Patients after Acute Coronary Syndrome.

Objective. The main aim of this study is to examine the achievement of low-density lipoprotein cholesterol (LDL-C) targets in older patients after acute coronary syndrome (ACS), and the secondary aim is to examine sex difference in LDL-C target achievement. Methods. Patients aged ≥60 years with ACS admitted to a tertiary hospital in Vietnam were recruited from December 2019 to August 2020. LDL-C target achievement was defined as having an LDL-C goal of <1.8 mmol/L. Multivariate logistic regression was applied to investigate the predictive factors for LDL-C target achievement. Results. A total of 232 participants were included in this study (mean age 75.5 years, 40.1% were women). Participants had an average of three chronic conditions other than coronary heart disease. All participants were prescribed statin monotherapy at discharge (59.5% on high-intensity statins). After 3 months, 218 (94.0%) of the participants were on statin monotherapy, 14 (6.0%) were on statin combined with ezetimibe. The proportion of participants that achieved LDL-C target after 3 months was 56.5% (40.9% in women and 66.9% in men, p < 0.001). On univariate logistic regression, women were less likely to achieve their LDL-C target compared to men (unadjusted OR 0.34, 95% CI 0.20–0.59). This association was still significant in the adjusted model (adjusted OR 0.43, 95% CI 0.24–0.78). Other factors that were significantly associated with LDL-C target achievement included age, smoking, sedentary lifestyle, LDL-C level on admission, history of using statin before admission, and high-intensity statin prescribed at discharge. Conclusions. Our study found that nearly a half of older patients with ACS did not achieve their LDL-C target after 3 months, and suboptimal control of LDL-C was more common in women.

Evaluating adherence to concomitant diabetes, hypertension, and hyperlipidemia treatments and intermediate outcomes among elderly patients using marginal structural modeling

Medication adherence to concomitant oral antidiabetics, statins, and renin-angiotensin system (RAS) antagonists (triple therapy) is vital to manage glycated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C) control among patients with comorbid diabetes, hyperlipidemia, and hypertension. The objective of the current study was to evaluate the association between adherence to concomitant triple therapy and A1C as well as LDL-C outcomes, among elderly patients using marginal structural modeling. A retrospective cohort study with patients on concurrent triple therapy was conducted using a Texas Medicare Advantage database from January 2016 until December 2019. Medication adherence to concurrent triple therapy was measured every 6 months using proportion of days covered (PDC) to determine the different adherence groups. A1C and LDL-C control was also measured every 6 months. A marginal structural model controlling for baseline covariates and time-varying confounders affected by prior adherence was conducted to evaluate the association between adherence to concomitant triple therapy and A1C and LDL-C control. The LDL-C cohort was comprised of 4803 patients and the A1C cohort was comprised of 5314 patients on triple therapy. Patients who were adherent to triple therapy [odds ratio(OR):1.84, 95% confidence interval (CI): 1.62-2.10] and adherent to double therapy (OR:1.42, 95% CI: 1.24-1.62) were more likely to have their LDL-C in control as compared to patient's adherent to monotherapy/none. Similarly, patients who were adherent to triple therapy (OR:1.30, 95% CI: 1.11-1.52) and adherent to double therapy (OR:1.32, 95% CI: 1.12-1.55) were more likely to have their A1C in control as compared to patient's adherent to monotherapy/none. The current study demonstrated the beneficial effects of adherence to concurrent oral antidiabetics, statins, and RAS antagonists among elderly patients in a real-world setting.

ATHERO: AN OBSERVATIONAL CROSS-SECTIONAL EVALUATION OF ATHEROSCLEROTIC RISK CONTROL IN THE BELGIAN POPULATION TREATED WITH AT LEAST ONE ANTIHYPERTENSIVE AND ONE LIPID-LOWERING DRUG

Objective: To evaluate real-life lipid and blood pressure (BP) control in a contemporary Belgian population sample treated with at least one lipid-lowering and one antihypertensive drug. Design and method: Data was collected through GP questionnaires on 2337 subjects (ATHERO STUDY). Results: A complete set of relevant clinical variables was available for 1706 subjects (61.5% men; mean age 67.9 ± 10.9 years; mean BMI 28.4 ± 4.9 kg/m2), in which CVD, CAD, DM and renal insufficiency were reported respectively in 34.0%; 22.2%, 37.5% and 6.6% of cases. Based on the 2016 EAS/ESC guidelines for the management of dyslipidemias, 68.8% of subjects were classified as very high risk (VHR) and 10.9% as high-risk (HR). Despite the majority (almost 70%) taking &gt; 1 antihypertensive drug, BP was uncontrolled in 44.0% (using the 140/90 mmHg threshold), without clear differences in control across risk strata. Treatment targets from the 2016 LDL-cholesterol guidelines were met in only 24.4% of VHR and 45.7% of HR subjects. For the new LDL-cholesterol targets 2019 ESC/EAS guidelines for the management of dyslipidemias (which came after the data collection) this would be 10.1% and 11.7%% respectively. GP’s estimated adequate BP control in 69.2% and LDL-cholesterol control in 63.4% of cases. Combined BP and LDL-cholesterol control was achieved in 16.1% of VHR and 26.9% of HR subjects. In the VHR group there was a clear gender disparity (11.7% of women compared to 18.6% of men) in achieving adequate combined control. More striking, combined control in those VHR subjects with a clinical condition (1040/1174 subjects) was 17.9% whilst in those with VHR due to risk factor combinations this was only 2.2%. Use of combination lipid-lowering and antihypertensive drug combinations was low (1.8%) whilst 66.5% of subjects were potential candidates. Conclusions: In GP practices, target achievement was very low for BP and even more so for LDL-cholesterol prevention targets amongst VHR patients, especially in those associated to risk factor combinations rather than more easily recognizable clinical conditions. There was a clear disparity between GPs’ estimates of risk factor control/target achievement and real-life figures in GP practices.

Sex-Related Differences in the Incidence and Development of Carotid Plaques in a Low-Income Chinese Population-A Prospective Cohort Study.

PurposeMore than 150 million people are estimated to have been examined for the presence of carotid plaques (CPs) in China; a sex-related imbalance in the prevalence exists. However, the relationship between sex and the incidence of CP development is unclear, especially in low-income areas of China. Hence, this study aimed to identify the sex differences in CP development and CP burden in both sexes in this population.MethodsThe study population included individuals aged ≥45 years in a rural area of Tianjin, China. Carotid ultrasonography was performed in the 2014 and 2019 cohorts, and information on carotid ultrasonography, including the formation and number of CPs, was collected twice. Logistic analyses were used to investigate the predictors of CP formation and numbers of plaques.ResultsA total of 1479 participants were analyzed. The incidence of CP was 20.3% and 29.0% in women and men, respectively. In women, high low-density lipoprotein cholesterol (LDL-C) levels was independent predictors of CP formation (RR: 1.217, 95%CI: 1.010, 1.461; P=0.039). For men, the corresponding predictors were hypertension, alcohol consumption, and low high-density lipoprotein cholesterol (HDL-C) levels (all P<0.05); none of the examined factors were associated with plaque numbers.ConclusionIn the study population, men had a higher incidence of plaque than women. Predictors of CP are different in men and women. LDL-C control is critical for moderating atherosclerosis in women; in men, managing blood pressure, stopping alcohol consumption, and controlling HDL-C levels are important.

High HDL-C and high LDL-C are risk factors of pterygium in a population-based cross-sectional study in Southern China: the Dongguan Eye Study

ObjectivesTo investigate the relationship between serum lipids and pterygium in a large-scale rural population aged 40 years or older from Southern China.Study designThe Dongguan Eye Study was a cross-sectional population-based...

Prevalence and Treatment of Familial Hypercholesterolemia and Severe Hypercholesterolemia in Older Adults in Ontario, Canada

BackgroundA simplified Canadian definition was recently developed to enable identification of individuals with familial hypercholesterolemia (FH) and severe hypercholesterolemia in the general population. Our objective was to use a modified version of this new definition to assess contemporary disease prevalence, treatment patterns, and low-density lipoprotein cholesterol (LDL-C) control in Ontario, Canada. MethodsWe identified individuals aged 66 to 105 years who were alive as of January 1, 2011, using the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) database, which was created by linking 19 population-based health databases in Ontario. Hypercholesterolemia was identified using LDL-C values. Cholesterol reduction and lipid-lowering treatment were assessed at time of diagnosis and after at least 2 and 5 years’ follow-up. ResultsAmong 922,464 individuals, 2440 (0.26%) met criteria for definite or probable FH, and 72,893 (7.90%) for severe hypercholesterolemia. At diagnosis, mean LDL-C concentration was 9.52 mmol/L for those with definite FH, 5.83 mmol/L for those with probable FH, 5.73 mmol/L for those with severe hypercholesterolemia, and 3.33 mmol/L for all other individuals. After > 5 years, LDL-C concentration remained elevated at 3.58 mmol/L for those with definite FH, 2.72 mmol/L for those with probable FH, and 2.93 mmol/L for those with severe hypercholesteremia. Use of statin therapy was initially high (83% of those with definite FH, 78% of those with probable FH, 62% of those with severe hypercholesterolemia); however, fewer patients remained on statins at follow-up at > 5 years (62% of those with definite FH, 67% of those with probable FH, 58% of those with severe hypercholesterolemia). ConclusionsAmong older Ontarians, we estimated that 1 in 378 individuals had FH, and 1 in 13 had severe hypercholesterolemia. Despite being at substantially increased cardiovascular risk, these patients acheived suboptimal LDL-C level control and fewer were on medical therapy at follow-up.

The CNIC-Polypill reduces recurrent major cardiovascular events in real-life secondary prevention patients in Spain: The NEPTUNO study

BackgroundTo evaluate the effectiveness of a cardiovascular polypill including aspirin, ramipril and atorvastatin (CNIC-Polypill), on the incidence of recurrent major cardiovascular events (MACE) and risk factor control in patients with established atherosclerotic cardiovascular disease (ASCVD) vs different pharmacological therapeutic strategies. MethodsRetrospective, observational study using data from electronic-health records. Patients were distributed into 4 different cohorts: CNIC-Polypill (case cohort) vs 3 control cohorts: same monocomponents taken separately (Monocomponents), equipotent drugs (Equipotent) and other drugs not included in the previous cohorts (Other therapies). Patients were followed for 2 years or until MACE or death. ResultsAfter propensity score matching, a total of 6456 patients (1614 patients per cohort) were analysed. After 2 years, the risk of recurrent MACE was lower in the CNIC-Polypill cohort compared to the control groups (22%; p = 0.017, 25%; p = 0.002, 27%; p = 0.001, higher in the Monocomponents, Equipotent and Other therapies cohorts, respectively). The incremental proportion of patients who achieved blood pressure (BP) and low-density lipoprotein cholesterol (LDLc) control from baseline was higher in the CNIC-Polypill cohort vs control cohorts (BP controlled patients: +12.5% vs + 6.3%; p < 0.05, +2.2%; p < 0.01, +2.4%; p < 0.01, LDLc controlled patients: +10.3% vs + 4.9%; p < 0.001, +5.7%; p < 0.001, +4.9%; p < 0.001, respectively). Medication persistence was higher in patients treated with the CNIC-Polypill (72.1% vs 62.2%, 60.0% and 54.2%, respectively; p < 0.001) at study end. ConclusionsIn secondary prevention patients, compared with control groups, treatment with the CNIC-Polypill was associated with significant reductions in the accumulated incidence of recurrent MACE, improved BP and LDLc control rates, and increased medication persistence.

Bempedoic acid and PCSK9 inhibitor eligibility in a contemporary population with atherosclerotic cardiovascular disease

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose The reduction of low-density lipoprotein cholesterol (LDL-C) in patients with established coronary heart disease (CHD) reduces the risk of atherosclerotic cardiovascular disease (ASCVD) events.(1) Many CHD patients fail to achieve guideline-recommended LDL-C targets without prohibitively expensive proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9 inhibitors).(2, 3, 4) This study aims to assess the impact that bempedoic acid may have on PCSK9 inhibitor eligibility in a population with CHD and ascertain whether its universal adoption would lead to overall cost-savings and a cost-effective reduction in ASCVD events. Methods and Results This retrospective analysis included 635 participants from the iASPIRE study, which recently assessed secondary prevention in an Irish cohort of CHD patients. We applied the 2019 ESC/EAS dyslipidaemia guideline LDL-C target of &amp;lt;1.4mmol/L and simulated the average treatment effect of improved lipid-lowering therapy with statins, ezetimibe and bempedoic acid. 86.3% of iASPIRE participants did not have LDL-C control and qualified for treatment intensification. Optimisation of statin therapy would allow 24.4% of patients to achieve their LDL-C goal, while the addition of ezetimibe would improve this to 55.7% leaving 44.3% eligible for a PCSK9 inhibitor. Utilising bempedoic acid would further reduce the proportion eligible to 18.7%. Based on current market prices and the universal application of ESC/EAS recommendations,(1, 5) the adoption of bempedoic acid would reduce the annual treatment costs associated with PCSK9 inhibitor use by almost 50% and result in cost savings per prevented CVD event. Conclusions The vast majority of CHD patients currently fail to achieve the recommended LDL-C target in everyday clinical practice. Ezetimibe and optimised statin therapy would enable most patients to meet their LDL-C goal. Employing bempedoic acid in patients with poor LDL-C control would significantly reduce the requirement for PCSK9 inhibitors and lead to cost savings per prevented CVD event.

Bempedoic Acid: A New Tool for LDL-Cholesterol Control in Patients with Coronary Artery Disease.

Nowdays a small proportion of patients with high/very high/extreme atherosclerotic cardiovascular disease risk achieves the optimal target of LDL-cholesterol, because of drug intolerance, poor adherence to the therapy, or inapplicability of the stepwise strategy in lipid lowering therapy, recommended by the current guidelines. The new oral agent bempedoic acid lowers plasma LDL-cholesterol by inhibiting adenosine triphosphate-citrate lyase, an enzyme involved in the synthesis of cholesterol, and, ultimately, by up-regulating the LDL receptors. Several clinical trials in patients with atherosclerotic cardiovascular disease or familial heterozygous hypercholesterolemia demonstrated that bempedoic acid alone or combined with statins and/or ezetimibe significantly reduced LDL-cholesterol and high-sensitivity C-reactive protein. Bempedoic acid is well tolerated with no significant increase in muscle-related symptoms, since it can be activated only in the liver but not in the skeletal muscles. Bempedoic acid provides an effective tool to further reduce LDL-cholesterol as add on therapy in patients unable to reach the target despite maximally tolerated lipid lowering therapy.

Achievement of guideline recommended diabetes treatment targets and health habits in people with self-reported diabetes in India (ICMR-INDIAB-13): a national cross-sectional study

There is little information on comprehensive diabetes care comprising glycaemic, lipid, and blood pressure control in India; therefore, we aimed to assess the achievement of treatment targets among adults with self-reported diabetes. The Indian Council of Medical Research (ICMR)-India Diabetes (INDIAB) study is a cross-sectional, population-based survey of adults aged 20 years or older in all 30 states and union territories of India. We used a stratified multistage sampling design, sampling states in a phased manner, and selected villages in rural areas and census enumeration blocks in urban areas. We used a three-level stratification method on the basis of geography, population size, and socioeconomic status for each state. For the outcome assessment, good glycaemic control was defined as HbA1c of less than 7·0% (A), blood pressure control was defined as less than 140/90 mm Hg (B), and the LDL cholesterol target was defined as less than 100 mg/dL (C). ABC control was defined as the proportion of individuals meeting glycaemic, blood pressure, and LDL cholesterol targets together. We also performed multiple logistic regression to assess the factors influencing achievement of diabetes treatment targets. Between Oct 18, 2008, and Dec 17, 2020, 113 043 individuals (33 537 from urban areas and 79 506 from rural areas) participated in the ICMR-INDIAB study. For this analysis, 5789 adults (2633 in urban areas and 3156 in rural areas) with self-reported diabetes were included in the study population. The median age was 56·1 years (IQR 55·7-56·5). Overall, 1748 (weighted proportion 36·3%, 95% CI 34·7-37·9) of 4834 people with diabetes achieved good glycaemic control, 2819 (weighted proportion 48·8%, 47·2-50·3) of 5698 achieved blood pressure control, and 2043 (weighted proportion 41·5%, 39·9-43·1) of 4886 achieved good LDL cholesterol control. Only 419 (weighted proportion 7·7%) of 5297 individuals with self-reported diabetes achieved all three ABC targets, with significant heterogeneity between regions and states. Higher education, male sex, rural residence, and shorter duration of diabetes (<10 years) were associated with better achievement of combined ABC targets. Only 951 (weighted proportion 16·7%) of the study population and 227 (weighted proportion 36·9%) of those on insulin reported using self-monitoring of blood glucose. Achievement of treatment targets and adoption of healthy behaviours remains suboptimal in India. Our results can help governments to adopt policies that prioritise improvement of diabetes care delivery and surveillance in India. Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare.

IDF21-0481 The burden of inadequately controlled risk factors for type 2 diabetes in Hong Kong: A population-based modelling study

Background: The economic and clinical burden of diabetes is well-established, yet a substantial proportion of people with diabetes have inadequate control of risk factors. Adherence to glycaemic, blood pressure and LDL-cholesterol targets could reduce the disease burden and save medical costs. Aim: To estimate the clinical and economic burden of diabetes associated with inadequate control of type 2 diabetes risk factors in Hong Kong over the next 10 years. Method: Population-based data of 590,008 people diagnosed with type 2 diabetes from January to December 2017 was obtained from the Hong Kong Hospital Authority electronic health records. The Hospital Authority system provides care for 95% of people with diabetes in Hong Kong. Immediate control of blood glucose, blood pressure and LDL-cholesterol (separately and combined) was compared to constant baseline levels, with outcomes projected over 10 years using the validated Chinese Hong Kong Integrated Modelling and Evaluation (CHIME) Diabetes model. Risk factor control was defined by American Diabetes Association (ADA) guidelines as glycated haemoglobin (HbA1c) targets <7% (53 mmol/mol), blood pressure <130/80 mmHg, and LDL-cholesterol <2.6 mmol/L. Quality-adjusted life years (QALYs) were calculated based on a meta-analysis of Asia-specific utility weights for diabetes and related complications. Direct medical costs were estimated from a health care provider perspective. Results: Immediate control of blood glucose, blood pressure and LDL-cholesterol was associated with population-level increases of 36,939 QALYs and 23,921 life-years with medical cost savings of USD 5.4 billion over 10 years compared to constant baseline risk levels. On an individual-level, immediate control of individual risk factors was associated with small gains of 0.06 QALYs, 0.04 life-years, and cost savings of USD 9,114 at 10 years. Among the individual risk factors, glycaemic control was associated with the greatest QALY gains and blood pressure control with the greatest medical cost savings.Tabled 1IndividualPopulationCombinedHbA1cBPLDLCombinedHbA1cBPLDLQuality-adjusted life years5 years0.020.020.010.0112,26911,4686,3915,35610 years0.060.060.040.0336,93935,71422,89220,476Life expectancy, years5 years0.010.0200.017,5488,9001,7233,49810 years0.040.050.020.0223,92127,58910,52814,475Medical cost savings, USD5 years5,1973,9014,9762,9723.1bn2.3 bn2.9 bn1.8 bn10 years9,1146,6438,5975,0545.4bn3.9 bn5.1 bn3.0 bnAbbreviations: HbA1c, glycated haemoglobin; BP, blood pressure; LDL, LDL-cholesterol, bn, billion. Open table in a new tab Abbreviations: HbA1c, glycated haemoglobin; BP, blood pressure; LDL, LDL-cholesterol, bn, billion. Discussion: The clinical and economic burden from inadequate control of risk factors in Hong Kong is substantial, particularly on a population-level. This disease burden is potentially reducible by early intervention and adherence to risk factor targets.

Current management and screening of peripheral and coronary artery disease in people with diabetes mellitus in Europe. The PADDIA/CADDIA survey

AimsThis survey aimed to evaluate the current management and screening of coronary artery disease and peripheral artery disease in people with type 2 diabetes mellitus (T2DM) in Europe, utilizing the 2013 ESC/EASD (European Society of Cardiology/European Association for the Study of Diabetes) guidelines as a benchmark. MethodsThe PADDIA/CADDIA survey is a European medical research collaboration targeting cardiologists, vascular physicians, diabetologists and general practitioners from Austria, Belgium, France, Germany, Italy, Netherlands and United Kingdom. ResultsThe questionnaire was completed by sixty-three physicians, of whom 75% declared assessing the cardiovascular risk of people with T2DM mostly without using a risk score (59%). More than 90% of the panel, check HbA1c, blood pressure and low-density lipoprotein cholesterol targets in their patients with T2DM and coronary or peripheral artery disease. For 94% the presence of T2DM influence their patients’ management, by optimizing blood glucose, blood pressure and low-density lipoprotein cholesterol control. Only 37% considered screening for lower extremity peripheral artery disease among their T2DM patients and 35% among those with cardiovascular disease. ConclusionsPhysicians mostly follow the ESC/EASD 2013 guidelines, but when it comes to screening for additional conditions including coronary artery disease or peripheral artery disease, or intensifying the antithrombotic regimen there is need for better guidance.

Contemporary Treatment Gaps in the Implementation of Ldl Cholesterol Control Among High- And Very High-Risk Patients in Europe between 2020–2021 – The Multinational Santorini Study

Contemporary Treatment Gaps in the Implementation of Ldl Cholesterol Control Among High- And Very High-Risk Patients in Europe between 2020–2021 – The Multinational Santorini Study

Control of Low-Density Lipoprotein Cholesterol in Secondary Prevention of Coronary Artery Disease in Real-Life Practice: The DAUSSET Study in French Cardiologists.

Introduction: Patients with established coronary artery disease (CAD) are at very high risk for cardiovascular events. Methods: The DAUSSET study is a national, multicenter, non-interventional study that included very high-risk CAD patients followed by French cardiologists. It aimed to describe real-life clinical practices for low-density lipoprotein (LDL) cholesterol control in the secondary prevention of CAD. Results: A total of 912 patients (mean age, 65.4 years; men, 76.1%; myocardial infarction, 69.4%; first episode, 80.1%) were analyzed. The LDL cholesterol goal was 70 mg/dL in most cases (84.9%). The LDL cholesterol goal <70 mg/dL was achieved in 41.7% of patients. Of the 894 (98.0%) patients who received lipid-lowering therapy, 81.2% had been treated more intensively after the cardiac event, 27.0% had been treated less intensively and 13.1% had been maintained. Participating cardiologists were very satisfied or satisfied with treatment response in 72.6% of patients. Moderate satisfaction or dissatisfaction with lipid-lowering therapy was related to not achieving objectives (100%), treatment inefficacy (53.7%), treatment intolerance (23.4%) and poor adherence (12.3%). Conclusion: These real-world results show that lipid control in very high-risk patients remains insufficient. More than half of the patients did not achieve the LDL cholesterol goal. Prevention of cardiovascular events in these very high-risk patients could be further improved by better education and more intensive lipid-lowering therapy.