Prevention & lipidsCross-sectional study
An estimation of the consequences of reinforcing the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines on current lipid-lowering treatment in patients with type 2 diabetes in tertiary care—a SwissDiab study
- Cross-sectional analysis of a multicentre longitudinal observational registry (modelling study)
- real-world
- theoretical treatment intensification
Authors' conclusion
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.
Study context
- Population
- Outpatients with T2DM in tertiary diabetes care (Swiss Diabetes Registry) with a visit 1 January 2018–31 August 2019 who failed the 2016 low-density lipoprotein cholesterol (LDL-C) target74.8% failed 2016 target
- Participants
- 294 outpatients
- Exposure
- Attaining 2016 vs 2019 ESC/EAS LDL-C targets
- Outcome
- Feasibility and cost of attaining guideline-recommended LDL-C targets, and CV benefit (MACE prevented)
Main finding
As reported in the abstract
Theoretical target attainment by treatment modification
High-intensity statin
Ezetimibe
PCSK9i
Ezetimibe and PCSK9i
| Outcome | 2016 target | 2019 target |
|---|---|---|
| Failed to reach target | one (0.3%) | five (1.7%) |
Observational data: associations, not effects.
Further findings
Additional annual medication cost per patient
events
| Outcome | 2016 target | 2019 target |
|---|---|---|
| Estimated 4-year MACE (from 24.9 events at baseline) | 18.6 | 17.4 |
- Estimated 4-year major adverse cardiovascular events (MACE) (from 24.9 events at baseline): baseline estimate 24.9 events
Original publication
An estimation of the consequences of reinforcing the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines on current lipid-lowering treatment in patients with type 2 diabetes in tertiary care—a SwissDiab study. Eur J Prev Cardiol. Published 25 May 2023. doi:10.1093/eurjpc/zwad178
Summarised from the published abstract; every number is checked against it