Endocrine Abstracts

Background and aims: Cardiovascular (CVS) disease accounts for the majority of morbidity and mortality in diabetes. We audited lipid management in a hospital diabetes clinic.

Patients: CVS disease risk factors were assessed in 241 consecutive patients with diabetes (type1 15%, type2 85%, male 53%, female 47%, mean age 59±13 years, mean duration of diabetes 10±9 years). 86(36%) had symptomatic atherosclerotic vascular disease (secondary prevention SP) and 155 (64%) did not (primary prevention PP).

Results: Overall, 37% were on statins, 7.5% on fibrates and 1% on acipimox. Combination hypolipidemic therapy was prescribed to 5 patients. In SP, mean total cholesterol (TC), HDL, LDL and triglycerides were 5.0, 1.3, 2.8 and 2.0 mmol/l respectively. Corresponding values for PP was 5.3, 1.4, 3.0 and 2.0 mmol/l. Mean TC in SP was significantly lower than PP (p=0.04), likely due to more intensive intervention and better compliance. Mean LDL and triglycerides were similar, though HDL was lower in SP (p=0.03). Target TC (less than 5.0 mmol/l) was achieved in 49% SP, 22% PP with 10-year coronary heart disease (CHD) risk greater than 30% and 38% PP with 10-year CHD risk 15%-30%. In PP, median 10-year CHD risk was 15%. Only 9 (6%) of these patients had 10-year CHD risk greater than 30%, none were on hypolipidemic therapy. Three patients were above 80 years age and 2 had TC less than 5.0 mmol/l.

Conclusion: Targeted therapy of PP patients with 10-year CHD risk greater than 15% is recommended. Strategies to increase HDL and further intensified therapy, if necessary with combinations of hypolipidemic agents, is recommended in SP.