Non-achievement of the Low-Density Lipoprotein Cholesterol Goal in Older Patients with Type 2 Diabetes Mellitus and a Very High Cardiovascular Disease Risk: A Multicenter Study in Vietnam

Abstract

Background: Lowering the low-density lipoprotein cholesterol (LDL-c) level is important for reducing cardiovascular (CV) events. However, little is known about the management of LDL-c in older patients with type 2 diabetes mellitus (T2DM). This study investigated the prevalence and factors associated with the non-achievement of LDL-c goals in older T2DM patients with a very high risk of CV diseases. Methods: This multicenter cross-sectional study measured the LDL-c levels of 733 T2DM outpatients from December 2019 to July 2020. The patients were aged ≥60 years, had very high risks of CV disease, and had been on LDL-c-lowering therapy for 6 months or more. The goal of lipid concentrations were assessed based on the recent guidelines of the European Society of Cardiology. We applied logistic regression analysis to identify the factors associated with the non-achievement of the LDL-c goal. Results: The mean age of the patients was 68.6±7.2 years. In total, 654 patients (89.2%) did not achieve the aggressive LDL-c goal of <1.4 mmol/L. In the adjusted model, the factors associated with the non-achievement of the LDL-c goal were obesity defined by body mass index (odds ratio [OR]=2.33; 95% confidence interval [CI], 1.13–4.81; p=0.022) and high-intensity statin therapy (OR=0.03; 95% CI, 0.01–0.05; p<0.001), while age, sex, education level, smoking habit, and comorbidities were not associated.Conclusion: Older patients with T2DM who are at a very high CV disease risk are often unable to achieve their LDL-c goal. Obesity can increase the probability of not achieving the LDL-c goal, whereas high-intensity statin therapy can decrease this probability.

The prevalence of excess weight among Vietnamese adults: A pooled analysis of 58 studies with more 430 thousand participants over the last three decades

“…Of those studies, 79 publications were expunged from consideration in the first round of screening (looking at title and abstract) because of the systematic review, literature review, participants under the age of 18, pregnant females and studies carried out elsewhere (outside Vietnam). At the conclusion of the process, a total of 276 publications were read in their entirety, and out of those, 58 papers satisfied the criteria to be included in this systematic review and meta-analysis (Au et al ., 2010; Binh et al ., 2015; Bui Van et al ., 2018; Cao et al ., 2019; Cuong et al ., 2007, 2018; Dao-Tran et al ., 2018; Dao-Tran and Seib, 2018; Dao et al ., 2010, 2011; Do et al ., 2004, 2015; Duc Cong and Dung, 2014; Fitzpatrick et al ., 2012; General Statistical Office, 2020; Ha et al ., 2011, 2013; Hien et al ., 2018; Ho-Pham et al ., 2013, 2014, 2015, 2019; Ho-Pham, Chau, et al ., 2018; Ho-Pham, Ho-Le, et al ., 2018; Hoang et al ., 2020; Kim et al ., 2010; Laillou et al ., 2013, 2014; Lan et al ., 2009; Le et al ., 2021; Luu et al ., 2021; Menzies Research Institute Tasmania, 2009; Minitry of Health (Vietnam), 2016; Miyakawa et al ., 2017; Mizuno et al ., 2021; HG Nguyen et al ., 2021; HT Nguyen et al ., 2021; Nguyen et al ., 2007, 2009, 2014, 2018; Nguyen, Pham, Do, et al ., 2012; Nguyen, Pham, Nguyen, et al ., 2012; NTT Nguyen et al ., 2021; Pham Thi Dung, Nguyen Trong Hung, Do Van Vuong, Pham Ngoc Khai, Pham Thi Kieu Chinh, Phan Huong Duong, 2020;…”

The Chinese Metabolic Management Centers

“…Of 733 older persons in Vietnam with type 2 diabetes and high cardiovascular disease risk, 11% achieved low‐density lipoprotein (LDL) cholesterol goal, and 51% achieved glycosylated hemoglobin (HbA1c) goal. 2 In a similar study of 465 adults with diabetes in Brazil, 46% achieved HbA1c goal, 51% blood pressure goal, and 40% LDL cholesterol goal. 3 In an Iranian study of 2008 persons with diabetes, 78% had HbA1c <8%, and 87% had blood pressure <140/90.…”

“…Current studies suggest that medical care is not usually optimized for people with diabetes. Of 733 older persons in Vietnam with type 2 diabetes and high cardiovascular disease risk, 11% achieved low‐density lipoprotein (LDL) cholesterol goal, and 51% achieved glycosylated hemoglobin (HbA1c) goal 2 . In a similar study of 465 adults with diabetes in Brazil, 46% achieved HbA1c goal, 51% blood pressure goal, and 40% LDL cholesterol goal 3 .…”