Abstract

Introduction: The control of low-density lipoprotein (LDL) cholesterol is a critical concern, especially for patients with diabetes, where the use of statins is essential. Despite this necessity, actual treatment practices and the achievement of LDL cholesterol targets are often suboptimal. This study aimed to assess the rate of LDL cholesterol goal attainment and examine statin prescribing habits within the cardiology and endocrinology departments of a tertiary hospital in Ho Chi Minh City, Vietnam.

Methods: This retrospective study encompassed 515 diabetic patients. We performed cardiovascular risk stratification to set appropriate LDL cholesterol goals for each patient. Through both univariate and multivariate analyses, we identified factors that influence LDL cholesterol management. Additionally, we reviewed patients' statin prescriptions before and after LDL cholesterol evaluation to understand prescribing patterns.

Results: Our study found that all included patients were categorized as having high or very high cardiovascular risk. A significant majority, 88.2%, were prescribed statins at an intermediate intensity. However, only 15.3% achieved their LDL cholesterol targets—21.7% in the high-risk category and a mere 9.4% in the very high-risk group. Factors conducive to effective LDL cholesterol management included being female, belonging to the very high cardiovascular risk group, and concurrent use of fibrates. Noticeably, among patients not meeting their LDL cholesterol goals, only 10.1% had their statin dosage increased post-evaluation. It was also observed that endocrinologists tended to reduce or discontinue statin dosages more often than cardiologists.

Conclusions: The rate at which diabetic patients in Vietnam meet their LDL cholesterol targets is alarmingly low. Priority should be given to female patients and those at very high cardiovascular risk to improve target attainment rates. There is a clear need for targeted interventions to enhance statin prescribing practices and, by extension, the management of LDL cholesterol in this population.

Introduction

Dyslipidemia significantly increases the risk of cardiovascular diseases; therefore, effective management, specifically in controlling low-density lipoprotein (LDL) cholesterol, is imperative. Statins are the primary treatment for lowering LDL cholesterol due to their proven efficacy in reducing cardiovascular events. Recent guidelines emphasize the need for stricter LDL cholesterol targets for individuals at high or very high cardiovascular risks - a category that diabetic patients almost invariably fall into. This underscores the need for rigorous LDL cholesterol management in these individuals1, 2.

Despite clear guidelines, reaching LDL cholesterol targets often remains a challenge in clinical practice, even in developed countries. It is reported that only 35% and 14% of patients have met the LDL cholesterol targets recommended by the 2016 and 2019 ESC-EASD (European Society of Cardiology/European Association for the Study of Diabetes) guidelines, respectively3. This shortfall is attributed to various factors, including the prescription habits across different medical specialties.

Analysis shows a significantly lower rate of statin use among patients with type 2 diabetes in endocrinology departments compared to their counterparts in cardiology departments. Notably, the achievement of LDL cholesterol targets is significantly higher in patients managed within cardiology departments than those in endocrinology departments4. Hence, this study aims to investigate the real-world management of LDL cholesterol and the statin prescription patterns among diabetic patients attending cardiology and endocrinology outpatient clinics at a tertiary hospital in Vietnam. By identifying potential disparities between these specialties, the study seeks insights that could lead to enhanced management strategies. Additionally, it explores the risk factors that hinder the achievement of optimal LDL cholesterol control, aiming to find solutions to improve patient outcomes.

Table 1.

Baseline characteristics of the participants

Total (N = 515) Cardiology clinic (N = 331) Endocrinology clinic (N = 184) P -value Demographic features Female 290 (56.3) 186 (56.2) 104 (56.5) 0.943 Age 66 (60-72) 67 (61-73) 64 (59-70) Comorbidities Hypertension 500(97.1) 318 (96.1) 182 (98.9) 0.066 CCS 246 (47.8) 198 (59.8) 48 (26.1) Heart failure 25 (4.9) 25 (7.6) 0 Atrial fibrillation 30 (5.9) 29 (8.8) 1 (0.5) Stroke 13 (2.5) 9 (2.7) 4 (2.2) 0.779 PAD 3 (0.6) 3 (0.9) 0 0.556 CKD 48 (9.3) 21 (6.3) 27 (14.7) Thyroid disease 12 (2.4) 7 (2.1) 5 (2.7) 0.664 Lung disease 5 (1.0) 3 (0.9) 2 (1.1) 1.000 Joint disease 44 (8.5) 19 (5.7) 25 (13.6) Laboratory results Hemoglobin (g/L) 135 (124-144) 135 (124-143) 135 (123-145) 0.253 HbA1C (%)