Objective: The 2016 ESC Dyslipidemia guidelines established LDL-cholesterol and HbA1c targets at 70 mg/dl and 7% for patients at very-high cardiovascular risk. The 2019 Dyslipidemia guidelines set LDL-cholesterol targets as low as 55 mg/dl for patients with diabetes, hypertension and atherosclerotic cardiovascular disease (ASCVD) or severe chronic kidney disease (CKD), while maintaining 70 mg/dl targets for patients at high cardiovascular risk. The purpose of our study was to establish a baseline of LDL-cholesterol target achievement based on past years’ experience. Design and method: We performed a retrospective study on patients admitted to our Internal Medicine and Cardiology Department, from January 2014 to December 2018. All patients had arterial hypertension (HTN) and type 2 diabetes mellitus (T2DM). Data regarding patient demographics, comorbidities and laboratory assay results (including glycemia, glycated hemoglobin and a complete lipid profile) were recorded. Data analysis was performed using SPSS version 20. Results: A total of 1239 patients were enrolled with a mean age of 71.3 ± 10.1 years and a slight female predominance (59.4% female). All patients were at very-high risk according to 2016 guidelines, but only 56.3% based on 2019 guidelines: 54.3% had ASCVD and 4.2% had severe CKD. LDL-cholesterol target achievement was 28.6% and 12.4% according to 2016 and 2019 ESC recommendations. The overall mean LDL-cholesterol value was 97.1 ± 39.4 mg/dl, but LDL-cholesterol values were lower after 2016 (93.4 vs. 100.7, p = 0.030) supposedly owing to the publication of the guideline. In terms of HbA1c targets achievement, overall HbA1c was 7.2 ± 1.5% and there was no difference in target achievement before and after 2016: 60.1% vs. 53.8%, p = 0.105. Conclusions: Our study shows that very few patients reach the desired treatment goals but lower targets equal better control of risk factors. We also believe that the timing of guideline publication may have an effect on risk factor correction: yearly publications from the American Diabetes Association may help as a reminder about target HbA1c levels, leading to tighter control.

Objective: NLR (neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are parameters associated with a higher mortality in patients with atherosclerotic cardiovascular disease (ASCVD). The purpose of our study was to determine if there were any differences in NLR or PLR in very-high risk patients who achieve LDL-cholesterol < 55 mg/dl and those who do not. Design and method: We performed a unicentric, retrospective study on hypertensive, diabetic patients admitted to the Internal Medicine and Cardiology Department from 2014 to 2018. Demographics, comorbidities and laboratory test results were recorded including complete blood count, erythrocyte sedimentation rate (ESR) and lipid profile. Data analysis was performed using SPSS version 20. Results: A total of 1239 patients were enrolled with a mean age of 71.3 ± 10.1 years and a slight female predominance (59.4% female). Little over half of patients (56.3%) had very-high cardiovascular risk: 54.3% had ASCVD and 4.2% had severe CKD, while all other had high CV risk. There were no significant differences in terms of NLR and PLR between patients at high or very-high CV risk as long as the LDL-cholesterol target was met (3.589 vs. 4.745, p = 0.163; 153.9 vs. 196.5, p = 0.055). However, if LDL-cholesterol targets were not achieved, there were NLR and PLR were higher in patients with very-high CV risk (2.857 vs. 3.940, p < 0.001; 143.5 vs. 174.0, p = 0.001). Both NLR and PLR had a positive correlation with ESR irrespective of high or very-high CV risk (NLR: r = 0.153 p = 0.022 vs. r = 0.264, p < 0.001; PLR: r = 0.214, p = 0.001 vs. r = 0.278, p < 0.001). Conclusions: Tighter cholesterol control has a significant role in lowering cardiovascular risk. Our study shows that based on NLR and PLR very-high risk patients who achieve the LDL-cholesterol target of 55 mg/dl have the same risk of CV events as patients who are at high CV risk.