Attainment of LDL-cholesterol target in high cardiovascular risk type 1 diabetic French people - 02/08/24

Doi : 10.1016/j.diabet.2024.101568

Cyril Breuker ^a, Valérie Macioce ^b, Alexandre Lasse ^a, Marie-Lou Zogheib ^c, Leslie Cavallin ^c, Fanchon Herman ^b, Marie-Christine Picot ^d, Pierre Gourdy ^e,^f, Brigitte Sallerin ^c, Ariane Sultan ^g,^⁎
^a Clinical pharmacy department, CHU Montpellier, Univ Montpellier, Montpellier, France
^b Clinical research and epidemiology unit, CHU Montpellier, Univ Montpellier, Montpellier, France
^c Clinical pharmacy department, Toulouse University Hospital, Toulouse, France
^d Clinical Research and Epidemiology Unit, INSERM, Centre d'Investigation Clinique 1411, CHU Montpellier, Univ Montpellier
^e Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
^f Endocrinology, Diabetology and Nutrition Department, Toulouse University Hospital, Toulouse, France
^g Nutrition and diabetes department, CHU Montpellier, Univ Montpellier, Montpellier, France

^⁎Corresponding author: Pr Ariane Sultan, Département Nutrition-Endocrinologie-Diabète, Hopital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier, FranceDépartement Nutrition-Endocrinologie-DiabèteHopital Lapeyronie371 Avenue du Doyen Gaston GiraudMontpellier34295France

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ABSTRACT

Aims -

As people with type 1 diabetes have increased risk of cardiovascular morbi-mortality, management of cardiovascular risk factors is of crucial importance. We assessed the prevalence and factors associated with LDL-cholesterol (LDL-c) target achievement in patients with type 1 diabetes at high and very-high cardiovascular risk.

Methods -

In this observational multicenter study, we included hospitalized patients with type 1 diabetes who had a fasting blood lipid analysis at admission. Cardiovascular risk level and LDL-c target values were defined according to ESC/EAS guidelines into force at admission: LDL-c target for very-high risk (VHR) and high risk (HR) patients was 1.4 and 1.8 mmol/l respectively for patients included from September 2019 (2019 guidelines) and 1.8 and 2.6 mmol/l respectively for patients included in 2016-2019 (2016 guidelines). LDL-c target attainment was assessed in HR and VHR patients, and factors associated with attainment were identified with multivariable analysis.

Results -

We included 85 HR patients (median age 37y [interquartile range: 27;45], 64% females) and 356 VHR patients (49 [35;61] years, 42% females). In HR patients, 7% were treated with statins, and 35.3% achieved the LDL-c target. Increasing age (odds ratio 0.58 [95% confidence interval: 0.38;0.89]), body mass index (0.86 [0.75;0.98]), and HbA1c (0.69 [0.50;0.94]) were independently associated with lower odds of attaining LDL-c target. In VHR patients, 36% were treated with statins, and 17.4% achieved LDL-c target. Statin treatment (2.33 [1.22;4.43]), secondary prevention (2.33 [1.21;4.48]) and chronic renal failure (2.82 [1.42;5.61]) were associated with higher odds of attaining LDL-c target.

Conclusion -

Control of LDL-c is highly insufficient in both HR and VHR patients. Cardiovascular risk evaluation and better control of risk factors may help decrease cardiovascular morbi-mortality in patients with type 1 diabetes.