Characterisation and cholesterol management in patients with cardiovascular events and/or type 2 diabetes in the Netherlands

A cross-sectional study was performed to describe characteristics and cholesterol management of patients with high cardiovascular risk in the Netherlands.

From the PHARMO Database Network a cross-sectional cohort was constructed including patients on lipid modifying therapy (LMT) in 2009 who were classified as high cardiovascular risk based on a history of type 2 diabetes mellitus (T2DM) or cardiovascular events (CVE, i.e. acute coronary syndrome or stroke), and who had LDL-C levels above 1.8 mmol/L at the time of the last LDL-C measurement in 2010 (index date). This was the LDL-C target set by the European Society of Cardiology (ESC) in 2011. Subcohorts with higher risk were created: T2DM in combination with CVE from the T2DM cohort and multiple CVE from the CVE only cohort. Clinical characteristics and drug treatment were determined at the index date.

Of 10,864 very high risk patients, 66% had T2DM, 37% of which also had CVE. In the CVE only cohort (34%), 18% had multiple events. The diabetes cohort may have been overrepresented due to regular check-ups in the diabetes monitoring program in primary care.

T2DM vs CVE cohort characteristics were: 53% vs 63% male, 42% vs 27% obese, 19% vs 24% current smoker, 54% vs 51% systolic blood pressure <140 mmHg, with similar proportions in the subcohorts. Proportions reaching the Dutch guideline LDL-C target of <2.5 mmol/L were 56% (T2DM), 57% (T2DM+CVE), 48% (CVE only) and 53% (multiple CVE only). Frequencies of use of high intensity dose statin (simvastatin ≥80mg, atorvastatin ≥40mg or rosuvastatin ≥20mg) were 6% (T2DM), 9% (T2DM+CVE, CVE only) and 14% (multiple CVE only). 1-2% received additional ezetimibe and 3-5% received non-statin LMT only, including ezetimibe.

In conclusion, over 40% of the patients above ESC target (1.8 mmol/L) also did not reach the less stringent Dutch target for LDL-C (2.5 mmol/L), even in the higher risk groups, despite having received LMT. Therefore, management of hypercholesterolemia after CVE or T2DM should be optimized to improve cardiovascular outcomes. In addition, there is substantial room for improving other cardiovascular risk factors such as hypertension, smoking behavior and obesity.

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