Eduardo García Díaz1, Davinia Ramírez Medina2, Óscar Mauricio Morera Porras3, José Luis Cabrera Mateos4. 1. Unidad de Endocrinología, Hospital Dr. José Molina Orosa, Lanzarote, España. Electronic address: egardiac@gobiernodecanarias.org. 2. Unidad de Nefrología, Hospital Dr. José Molina Orosa, Lanzarote, España. 3. Unidad de Cardiología, Hospital Dr. José Molina Orosa, Lanzarote, España. 4. Unidad de Atención Primaria, Gerencia de Servicios Sanitarios de Lanzarote, Lanzarote, España.
Abstract
OBJECTIVE: To assess the control of cLDL in diabetic patients, to measure the impact on such control of inertia with lipid-lowering agents and to explore factors that allow for predicting this inertia. METHODS: Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target cLDL levels was estimated. Therapeutic inertia was considered when the dose of the lipid-lowering agents was not adjusted, or a lipid-lowering agent was not changed or added in patients with initial cLDL outside the target. Change in cLDL from the first to the last visit and inertia with lipid-lowering drugs were analyzed according to comorbidities, cardiovascular risk factors and treatments used. RESULTS: The study simple consisted of 639 patients (mean follow-up time 11.1±11.2 months), of whom 27.5% achieved target cLDL levels. Inertia occurred in 43,6% of patients with initial cLDL outside the target. Independent predictors of inertia were the initial cLDL (P<0.001), polyneuropathy (P=0.014), adjustment of antihypertensive agents (P=0.002), adequacy of lipid-lowering agents (P<0.001), use of ezetimibe (P=0.001) and adherence to lipid-lowering drugs (P=0.015). CONCLUSIONS: Inertia with lipid-lowering agents in a diabetic patient is less frequent in the presence of higher cLDL values, in cases of polyneuropathy, when antihypertensive agents are adjusted or changed, and when non-adherence is detected. The adequate initial prescription of statins and the association with ezetimibe decrease the likelihood of committing inertia.
OBJECTIVE: To assess the control of cLDL in diabeticpatients, to measure the impact on such control of inertia with lipid-lowering agents and to explore factors that allow for predicting this inertia. METHODS: Study of historical cohorts of diabeticpatients. The proportion of patients who achieved the target cLDL levels was estimated. Therapeutic inertia was considered when the dose of the lipid-lowering agents was not adjusted, or a lipid-lowering agent was not changed or added in patients with initial cLDL outside the target. Change in cLDL from the first to the last visit and inertia with lipid-lowering drugs were analyzed according to comorbidities, cardiovascular risk factors and treatments used. RESULTS: The study simple consisted of 639 patients (mean follow-up time 11.1±11.2 months), of whom 27.5% achieved target cLDL levels. Inertia occurred in 43,6% of patients with initial cLDL outside the target. Independent predictors of inertia were the initial cLDL (P<0.001), polyneuropathy (P=0.014), adjustment of antihypertensive agents (P=0.002), adequacy of lipid-lowering agents (P<0.001), use of ezetimibe (P=0.001) and adherence to lipid-lowering drugs (P=0.015). CONCLUSIONS: Inertia with lipid-lowering agents in a diabeticpatient is less frequent in the presence of higher cLDL values, in cases of polyneuropathy, when antihypertensive agents are adjusted or changed, and when non-adherence is detected. The adequate initial prescription of statins and the association with ezetimibe decrease the likelihood of committing inertia.
Authors: Walter Masson; Melina Huerín; Lorenzo Martin Lobo; Gerardo Masson; Graciela Molinero; Mariano Nemec; Mariela Boccadoro; Cinthia Romero; Gabriel Micali; Daniel Siniawski Journal: J Cardiovasc Dev Dis Date: 2020-02-05
Authors: Ana Cristina García-Ulloa; Claudia Lechuga-Fonseca; Fabiola Mabel Del Razo-Olvera; Carlos Alberto Aguilar-Salinas; Karla Ivette Galaviz; K M Venkat Narayan; Sergio Hernández-Jiménez Journal: BMJ Open Diabetes Res Care Date: 2021-02