Current Status of Dyslipidemia in Type 2 Diabetes Mellitus, Its Associated Factors, its Association with Vascular Complications and Patterns of Lipid Lowering Therapy in Maharat Nakhon Ratchasima Hospital

Abstract

Cardiovascular disease (CVD) is the major cause of death in diabetic patient. In order to decrease CVD, management of dyslipidemia is very important. American diabetes association (ADA) recommended that plasma LDL cholesterol should be <100 mg/dL. Currently (2005), ADA recommended more aggressive LDL target. Diabetic patients with plasma cholesterol >135 mg/dL must be treated except for the patients <40 years old. Plasma cholesterol must be lower by 30-40% with LDL <100 mg/dL for primary and 70 mg/dL for secondary CVD prevention. Uderstanding about current dyslipidemia status in people with diabetes is very important milestone for CVD Prevention diabetics. Objectives: To demonstrate a current status of dyslipidemia in type 2 diabetes mellitus, to demonstrate the associated factors of good lipid control, to demonstrate the association of lipid levels and the vascular complications and to demonstrate the patterns of lipid lowering therapy in Maharat Nakhon Ratchasima hospital. Material and Methods: One thousand type 2 diabetic patients who attended at least one year at diabetic clinics in Maharat Nakhon Ratchasima hospital from April to December 2003 were recruited. Individual demographic data including education, socioeconomic status, diabetic complications and plasma lipid concentration and other metabolic parameters within six months were recorded based on the ADA guideline. Results: There were 1,000 type 2 diabetes (Age 59.4±6.8 years, M:F 27.3%:72.7%) from1,066 diabetic patients. In this group, mean fasting plasma glucose was 151.9±54.2 mg/dL while HbA1c was 7.9±2.1 mg/dL. Seventy-five percent had hypertension, 6.1% had a history of coronary artery disease and 3.6% had a history of cerebrovascular disease. Plasma lipid profiles were mean total cholesterol of 203.8±47.2 mg/dL, mean LEL-C of 115.2±38.7 mg/dL, mean triglyceride of 164.7±106.7 mg/dL and mean HDL-C of 55.9±16.0 mg/dL. Only 34.4% took lipid lowering agents, 27.3% with statin only, 5.9% with fibrate only and 1.4% with a combination. More than half of diabetic patients (65.6%) did not take lipid lowering agents, even ones who had LDL-C>100 mg/dL. Conclusion: Elevated LDL cholesterol was the most importand dyslipidemia in diabetes. But only about 35% took lipid-lowering agents. The association between vascular complication and level of lipid control was demonstrated however correlation between cardiovascular disease and lipid level control was not identified.