心血管风险较高的法国 1 型糖尿病患者的低密度脂蛋白胆固醇目标值。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism Pub Date : 2024-08-03 DOI:10.1016/j.diabet.2024.101568

Cyril Breuker , Valérie Macioce , Alexandre Lasse , Marie-Lou Zogheib , Leslie Cavallin , Fanchon Herman , Marie-Christine Picot , Pierre Gourdy , Brigitte Sallerin , Antoine Avignon , Ariane Sultan

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引用次数: 0

摘要

目的--：由于 1 型糖尿病患者心血管疾病死亡风险增加，因此管理心血管风险因素至关重要。我们评估了心血管风险高和非常高的 1 型糖尿病患者中低密度脂蛋白胆固醇（LDL-c）达标的发生率和相关因素：在这项多中心观察性研究中，我们纳入了入院时进行过空腹血脂分析的 1 型糖尿病住院患者。心血管风险水平和 LDL-c 目标值根据入院时生效的 ESC/EAS 指南确定：2019年9月（2019年指南）纳入的极高风险（VHR）和高风险（HR）患者的LDL-c目标值分别为1.4和1.8毫摩尔/升，2016-2019年（2016年指南）纳入的患者的LDL-c目标值分别为1.8和2.6毫摩尔/升。评估了HR和VHR患者的低密度脂蛋白胆固醇目标达标情况，并通过多变量分析确定了与达标相关的因素：我们纳入了85名HR患者（中位年龄37岁[四分位间范围：27;45]，64%为女性）和356名VHR患者（49[35;61]岁，42%为女性）。在 HR 患者中，7% 接受了他汀类药物治疗，35.3% 达到了 LDL-c 目标值。年龄增加（几率比 0.58 [95% 置信区间：0.38;0.89]）、体重指数增加（0.86 [0.75;0.98]）和 HbA1c 增加（0.69 [0.50;0.94]）与低密度脂蛋白胆固醇达标几率降低独立相关。在 VHR 患者中，36% 接受了他汀类药物治疗，17.4% 达到了 LDL-c 目标值。他汀类药物治疗（2.33 [1.22;4.43]）、二级预防（2.33 [1.21;4.48]）和慢性肾功能衰竭（2.82 [1.42;5.61]）与较高的 LDL-c 达标几率相关：结论：HR 和 VHR 患者的低密度脂蛋白胆固醇控制非常不充分。心血管风险评估和更好地控制风险因素可能有助于降低 1 型糖尿病患者的心血管死亡率：NCT03449784。

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Attainment of LDL-cholesterol target in high cardiovascular risk type 1 diabetic French people

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.

Registration number

NCT03449784.

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来源期刊

Diabetes & metabolism 医学-内分泌学与代谢

CiteScore

12.00

自引率

4.20%

发文量

审稿时长

13 days

期刊介绍： A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.