Lipid and cardiometabolic features of T2DM patients achieving stricter LDL-C and non-HDL-C targets in accordance with ESC/EAS 2019 guidelines.

Background: New recommendations call for lowering LDL- < 55 mg/dL and non-HDL- < 85 mg/dL in very-high cardiovascular risk (VH-CVR) patients with type 2 diabetes (T2DM). This study assessed the proportion of VH-CVR diabetics currently meeting these primary and secondary lipid targets, and which therapies/phenotypes predict combined goals achievement.

Methods: We analysed the cardiometabolic phenotype, use of lipid-modulatind drugs (LMD), pre- and post-LMD lipids levels, and CV complications among 1196 T2DM with high ( = 221; 18%) or VH-CVR ( = 975; 82%). Among the latter, the characteristics of combined lipid goal-achievers ( = 158) were compared to those of non-achievers ( = 817), with subgroup analyses of on-statin patients ( = 732) and those with established CVD taking statins ( = 362). Presence of statin-associated muscle symptoms (SAMS) was also recorded.

Results: 75% of VH-CVR patients were on statins. Both LDL-C and non-HDL-C goals were achieved by 16.2% of all VH-CVR, 19.3% of on-statin VH-CVR, and 24.3% of patients with established CVD taking statins. Achieving both targets was associated with high-intensity statins, specifically rosuvastatin, [statin + ezetimibe] combination, lower baseline LDL-C, smaller LDLs, lower TG and lipoprotein(a), and reduced metabolic syndrome frequency. SAMS reporting did not differ between achievers and non-achievers.

Conclusions: More than 80% of patients are above targets. To bridge this gap, apart from treating more LMD-naive/refractory diabetics, one should consider for LDL-C to put most patients on high-intensity statins, more often with ezetimibe and, within statins, to switch preferably to rosuvastatin. As regards non-HDL-C, the off-target patients' phenotype suggests that intensifying lifestyle measures against metabolic syndrome should supplement current therapies.