[Screening for hyperlipidemia in cardiovascular high-risk patients in austrian diabetes ambulances]

Incidence of coronary heart disease is 2-4 fold increased in type 2 diabetic patients and diabetic dyslipidemia is a major risk factor.To reduce cardiovascular risk in diabetes decreasing LDL-cholesterol (LDL-C) is the major goal in lipid management. Evidence-based limits for LDL-C levels are for patients without cardiovascular complications <100 mg/dl and for patients with cardiovascular complications <70 mg/dl. The aim of the present screening initiative was to investigate the status quo of LDL-C levels in consecutively recruited diabetic patients suffering cardiovascu-lardisease.

A total of 921 type 2 diabetic patients with coronary, peripheral or central vascular complications were included in 2007 in 15 Austrian diabetes centers. Level of lipids and HbA(1c) were analyzed as well as data on patient's history and medical therapy were collected. Subjects (n=355) with LDL-C level <70 mg/dl at the beginning were not further evaluated. In the remaining 566 patients with baseline LDL-C >70 mg/dl, routine treatment was followed; 231 of them had a follow-up evaluation, 335 did notattend thecenterfor routine treatment again.

LDL-C at the beginning was < 70 mg/dl in 355 patients (38.5%), in between 70-100 mg/dl in 348 patients (37.8%) and > 100 mg/dl in 218 patients (23.7%). All butonepatientswerealreadytreatedwith lipid lowering agents at baseline, whereas 96.4% got at least one standard statin or a statin with high potency. During lipid therapythe percentage of standard statins decreased significantly (p < 0.0001), whereas the percentage of high potency statins increased significantly (p < 0.0001 ). The percentage of ezetimib also increased significantly (p < 0.0001), fibrate nearly remained constant. The median LDL-C levels decreased from 97 mg/dl at baseline to 77 mg/dl at follow-up in subjects who attended the sites for follow-up (n = 231).

This screening initiative demonstrated a more successful therapy if only lipid levels were followed more consequently.