Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

The benefit of secondary prevention with statin therapy in patients with established coronary heart disease (CHD) is well documented. Patients with MPD (triglyceride [TG] ≥2.3mmol/L with low HDL-C) have additional cardiovascular risk, which is not fully addressed by statin therapy. These patients may benefit from therapy with non-statin lipid lowering therapy such as fibrates and fish-oil.

We examined lipid profiles and vascular protection treatment strategies in 1949 consecutive outpatients treated by specialist cardiologists with a diagnosis of established CHD. Data for the sub-group of patients with comorbid diabetes (N=419) were similarly analysed.

A substantial proportion of patients had suboptimal lipid control: 727 (37.3%) had low HDL-C (<1.0mmol/L in men and 1.8mmol/L), and 190 (9.7%) had high TG (≥2.3mmol/L). Similar data were observed amongst patients with diabetes (Table 1). Treatment gaps were identified. Among patients with elevated LDL-C levels, most were treated with either high intensity (572 [63.2%]) or moderate/low intensity (250 [26.6%]) statin therapy; 34 patients (3.8%) were treated with fibrate or ezetimibe and 49 patients (5.4%) had no lipid-lowering therapy. MPD was observed in 121 (6.2%) of CHD patients. The prevalence of MPD was higher amongst patients with diabetes (N=54, 12.8%).  Only 13.2% of patients with MPD received fibrate therapy, with similar fibrate utilisation in diabetics (N=8, 14.8%) and non-diabetics (N=8, 11.9%).  

In our outpatient cohort, LDL > 1.8mmol/l was more common than MPD.  Nevertheless, MPD was observed in 6.2% of patients with CHD and 12.8% of those with CHD and diabetes. These patients may benefit from further medical or lifestyle interventions aimed at improving dyslipidaemia.