Hypolipidemic treatment improves the prognosis of diabetics. Why do we use it so modestly?

Česká verzia

Authors: Richard Češka ¹; Jiří Šilar ²
Authors place of work: Centrum preventivní kardiologie, III. interní klinika – klinika endokrinologie a metabolismu 1. LF UK a VFN v Praze ¹; Institut biostatistiky a analýz, s. r. o. ²
Published in the journal: AtheroRev 2021; 6(2): 67-72
Category: Reviews

Summary

Currently, the pandemic of non-communicable diseases - type 2 diabetes mellitus (T2DM), hyperlipoproteinemia and dyslipidemia (HLP and DLP) and cardiovascular diseases (CVD) - significantly threatens the health of the population worldwide. The treatment of HLP/DLP and in particular the treatment affecting the levels of LDL-cholesterol (LDL-C) has the potential to improve the prognosis of patients with DM2T and CVD. High-intensity statin therapy is necessary to achieve a reduction in LDL-C levels of at least 50% of the baseline values. Yet even an easily available treatment, such as the combination of a statin and ezetimibe, has not been in use. Because of that, a Prospective Observational Project, named ADVOKÁT Study, was conducted in 2019 and 2020 to assess the benefits of pharmacological intervention with hypolipidemics (statin, ezetimibe) in patients with T2DM. The aim of this observational project was to intensify the treatment of dyslipidemia according to the ESC/EAS recommendations (from 2017). The results of the ADVOKÁT study are summarized in the article.

Keywords:

ADVOKAT study – ezetimibe – hypolipidemics – statins

Zdroje

1. Pedersen TR, Kjekshus J, Berg K et al. Randomised trial of cholesterol lowering in 4 444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 334(8934): 1383–1389.

2. Baigent C, Blackwell L, Emberson J et al. [Cholesterol Treatment Trialists’ (CTT) Collaboration]. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376 (9753): 1670–1681. Dostupné z DOI: .

3. Mach F, Baigent C, Catapano A et al. 2019 ESC/EAS Guidelines for the management of dyslipidemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41(1):111–188. Dostupné z DOI: .

4. Christopher P, Cannon CP, Blazing MA et al. [IMPROVE-IT Investigators]. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015; 372(25): 2387–2397. Dostupné z DOI: .

5. Rossebø AB, Pedersen TR, Boman K et al. [SEAS Investigators]. Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis. N Engl J Med 2008; 359(13):1343–1356. Dostupné z DOI: .

6. Baigent C, Landray MJ, Reith C et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377(9784): 2151–2248. Dostupné z DOI: .

7. Gæde P, Lund-Andersen H, Parving HH et al. Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes. N Engl J Med 2008; 358(6): 580–591. Dostupné z DOI: .

8. Jimenez JG, Rosen JB, Pirags V et al. The efﬁcacy and safety of ezetimibe/ simvastatin combination compared with intensiﬁed lipid-lowering treatment strategies in diabetic subjects with and without metabolic syndrome. Diabetes Obes Metab 2013; 15(6): 513–522. Dostupné z DOI: .

9. Ginsberg HN, Elam MB, Lovato LC et al. [ACCORD Study Group]. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; 362(17): 1563–1574. Dostupné z DOI: .

10. Sattar N. Revisiting the links between glycaemia, diabetes and cardiovascular disease. Diabetologia 2013; 56(4):686–695. Dostupné z DOI: .

11. Waters DD, Ho JE, Boekholdt SM et al. Cardiovascular event reduction versus new-onset diabetes during atorvastatin therapy: effect of baseline risk factors for diabetes. J Am Coll Cardiol 2013; 61(2): 148–152. Dostupné z DOI: .

12. Watts GF, Ooi EM. Balancing the cardiometabolic benefits and risks of statins. Lancet 2012; 380(9841): 541–543. Dostupné z DOI: .

13. Betteridge DJ, Gibson JM. Effects of rosuvastatin on lipids, lipoproteins and apolipoproteins in the dyslipidaemia of diabetes. Diabet Med 2007; 24(5): 541–549. Dostupné z DOI: .

14. Stone NJ, Robinson JG, Lichtenstein AH et al. [American College of Cardiology/American Heart Association Task Force on Practice Guidelines]. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J Am Coll Cardiol 2014; 63(25 pt B): 2889–2934. Dostupné z DOI: .