Lipid and glycemic control in a population with concurrent type 2 diabetes mellitus and arterial hypertension

Introduction: Type 2 diabetes mellitus and hyperlipi-demia along with high blood pressure are cardiovascu-lar risk factors that increase the chances for developing of coronary artery disease; however, proper lifestyle changes and adequate medical treatment can lower this risk. The most recent Dyslipidemia guideline (publi-shed by the European Society of Cardiology in 2016) establishes a LDL cholesterol (LDL-C) target of 70 mg/ dL. This should be achieved by patients with diabetes mellitus type 2 and a history of cardiovascular or chro-nic kidney disease and patients over 40 with at least one cardiovascular risk factor and subclinical end-organ damage. Concurrently, appropriate glycemic control should be achieved through diet or use of anti-diabetic medication. Moreover, a target of glycated hemoglobin (HbA1c) of 7% helps prevent development of micro and macrovascular complications.
Objective: The purpose behind our study was to assess if adequate glycemic and lipid control (through HbA1c and LDL-C levels respectively) was achieved following the publication of 2016 Dyslipidemia guidelines.
Methods: A retrospective analysis was performed on inpatients presenting to our clinic between January 2016 and December 2017. Data from 1078 patients with arterial hypertension and diabetes mellitus type 2 was processed – out of whom 640 were women and 438 men with a mean age of 69.0 +/- 9.9. Laboratory assay results were collected for all patients including a com-plete lipid panel (cholesterol, triglycerides, LDL choles-terol, HDL cholesterol) and glycated hemoglobin. All those enrolled were above the age of 40 and had previ-ously been diagnosed with type 2 diabetes mellitus and arterial hypertension; thus, the desired target were 70 mg/dL for LDL-C and under 7% for HbA1c.
Results: More than half the patients (57%) had a his-tory of severe arterial hypertension (maximum systo-lic value over 180 mmHg=stage 3 hypertension), while 12% had stage 2 hypertension and 31% had grade 1 hypertension. The median LDL-C value was 87 mg/dl with a mean and standard deviation of 91.4 mg/dL and 38.1 mg/dL, respectively. Out of the lot, a mere 31.6% had LDL-C values under the 70 mg/dl target. In terms of glycemic control, the median value for glycated hemoglobin was 6.9% with a mean of 7.3% +/- 1.5%. Less than half the patients (46.5%) exhibited adequate glycemic control (HbA1c under 7%).
Conclusions: According to the above mentioned data, it has been made obvious that lipid and glycemic con-trol are suboptimal in the investigated population. It is apparent that more aggressive lifestyle changes along with treatment strategies of tighter control should be instated so as to prevent the development of cardiovas-cular complications. Consequently, more effort should be put behind enforcing guideline recommendations.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)