Buscar en
Endocrinología y Nutrición (English Edition)
Toda la web
Inicio Endocrinología y Nutrición (English Edition) Therapeutic approach to dyslipidemia and goal achievement in a Spanish populatio...
Journal Information
Vol. 58. Issue 6.
Pages 283-290 (June 2011)
Download PDF
More article options
Vol. 58. Issue 6.
Pages 283-290 (June 2011)
Full text access
Therapeutic approach to dyslipidemia and goal achievement in a Spanish population with type 2 diabetes without cardiovascular disease
Estrategia de tratamiento de la dislipemia y consecución de objetivos en la población española con diabetes tipo 2 sin enfermedad cardiovascular
Antonio Péreza,b,??
Corresponding author

Corresponding author.
, Cintia González Blancoa,c, Miguel Ángel Hernández-Presad, José Chavesd
a Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Ciber de Diabetes y Enfermedades Metabólicas (CIBERDEM)
c Ciber de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)
d Unidad Médica, Pfizer, Spain
Article information

To assess the therapeutic approach and lipid goal achievement in a Spanish diabetic population at high cardiovascular risk.

Subjects and methods

A multicenter, descriptive, cross-sectional study consecutively recruited the first 10 patients who attended the primary care unit and had been seen in the 12 months prior to the study visit. Inclusion criteria were type 2 diabetes without cardiovascular disease, LDL cholesterol levels ≤160mg/dL, triglyceride levels ≤600mg/dL, and at least one of the following: retinopathy, albuminuria, current smoking habit, or hypertension.


A total of 2412 patients were evaluated (aged 61.3±8.3 years, 46.8% women, diabetes duration 8.6±7.4 years). As compared to their previous visit (8.1±5 months before), the proportion of patients who achieved LDL-C levels <100mg/dL (22.7% vs 28.6%), non-HDL-C levels <130mg/dL (27.7% vs 33.8%) and both goals (17.6% vs 22.1%) significantly increased at the time of assessment. Statins were the most widely prescribed lipid-lowering drugs (65.5%) and the lipid-lowering drug was changed from the previous visit in 38.7% of patients, drug dosage was increased in 17.3%, and another drug was added in 5%.


The use of more potent statins and higher statin doses were the most commonly used therapeutic strategies for improving the control of dyslipidemia in patients with type 2 diabetes, but these changes were clearly inadequate to achieve lipid goals in most patients with type 2 diabetes.

Type 2 diabetes
Cardiovascular risk
Lipid goals
Lipid-lowering drugs

Evaluar la estrategia terapéutica y el grado de consecución de los objetivos lipídicos en la población española con diabetes y alto riesgo cardiovascular.

Sujetos y métodos

Estudio descriptivo, transversal y multicéntrico con inclusión mediante muestreo consecutivo de los 10 primeros pacientes que acudieron a consulta de Atención Primaria y que hubieran sido visitados durante los 12 meses previos al estudio. Se incluyeron pacientes con diabetes tipo 2 sin enfermedad cardiovascular, concentraciones de colesterol LDL (cLDL) ≤ 160mg/dl y triglicéridos ≤ 600mg/dl, y al menos uno de los siguientes: retinopatía, albuminuria, tabaquismo actual o hipertensión.


Se evaluaron 2.412 pacientes (edad: 61,3±8,3 años; 46,8% mujeres, duración de la diabetes de 8,6±7,4 años). En comparación con la visita previa (8,1±5 meses antes), en el momento de la evaluación, la proporción de pacientes con cLDL < 100mg/dl (22,7 vs 28,6%), c-noHDL < 130mg/dl (27,7 vs 33,8%) y la combinación de ambos (17,6 vs 22,1%) aumentaron significativamente. Las estatinas eran los fármacos hipolipemiantes más prescritos (65,5%) y, desde la visita previa, en el 38,7% de los pacientes se cambió el fármaco hipolipemiante, en el 17,3% se aumentó la dosis y en un 5% se añadió otro fármaco.


La utilización de estatinas de mayor potencia y el incremento de la dosis es la estrategia terapéutica más utilizada para mejorar el control de la dislipemia en los pacientes con diabetes tipo 2, pero estos cambios resultan claramente insuficientes para alcanzar los objetivos lipídicos en la mayoría de los pacientes con diabetes tipo 2.

Palabras clave:
Diabetes tipo 2
Riesgo cardiovascular
Objetivos lipídicos
Full text is only aviable in PDF
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).
JAMA, 285 (2001), pp. 2486-2497
D.C. Golf, H.C. Gerstein, H.N. Ginnsberg, W.C. Cushman, K.L. Margolis, R.P. Byington, ACCOR D Study Group, et al.
Prevention of cardiovascular disease in persons with type 2 diabetes mellitus: current Knowledge and rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCOR D) trial.
AM J Cardiol, 99 (2007), pp. 4i-20i
Scandinavian Simvastatin Survival Study Group.
Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4s).
Lancet, 344 (1994), pp. 1383-1389
F.M. Sacks, A.M. TonKin, T. Craven, M.A. Pfeffer, J. Shepherd, A. Keech, et al.
Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors: The Prospective Pravastatin pooling Project.
Circulation, 105 (2002), pp. 1424-1428
Heart Protection Study Collaborative Group.
MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial.
Lancet, 361 (2003), pp. 2005-2016
P. Gaede, P. Vedel, N. Larsen, G.V.H. Jensen, H.H. Parving, O. Pedersen.
Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
N Engl J Med, 348 (2003), pp. 383-393
S.M. Grundy, J.I. Cleeman, C.N. Merz, H.B. Brewer, L.T. Clark, D.B. Hunninghake, National Heart, Lung, and Blood Institute;American College of Cardiology Foundation;American Heart Association.
Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.
Circulation, 110 (2004), pp. 227-239
R.C. Turner, H. Millns, H.A.W. Neill, I.M. Stratton, D.R. Matthews, Holman RR, for the United Kingdom Prospective Diabetes Study Group.
Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS:23).
BMJ, 316 (1998), pp. 823-828
Heart protection Study Collaborative Group.
MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial.
H.M. Colhoun, D.J. Betteridge, P.N. Durrington, G.A. Hitman, H.A. Neil, S.J. Livingstone, on behalf of the CARDS investigators, et al.
Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaboratuve Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial.
S.J. Lewis, L.A. Moye, F.M. Sacks, D.E. Johnstone, G. Timmis, J. Mitchell, et al.
Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range Results of the Cholesterol and recurrent Events (CARE) trial.
Ann Intern Med, 129 (1998), pp. 681-689
R.B. Goldberg, M.J. Mellies, F.M. Sacks, L.A. Moyé, B.V. Howard, V.J. Howard, et al.
Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the Cholesterol and recurrent Events (CARE) trial.
The Care Investigators. Circulation, 98 (1998), pp. 2513-2519
B.G. Brown, X.Q. Zhao, A. Chait, L.D. Fisher, M.C. Cheung, J.S. Morse, et al.
Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.
N Engl J Med, 345 (2001), pp. 1583-1592
A.J. Taylor, S.M. Kent, P.J. Flaherty, L.C. Coyle, T.T. Markwood, M.N. Vernalis.
ARBITER: Arterial Biology for the investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravstatin on carotid intima medial thickness.
Circulation, 106 (2002), pp. 2055-2060
A.J. Taylor, L.E. Sullenberger, H.J. Lee, J.K. Lee, K.A. Grace.
Arterial Biology for the investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind placebocontrolled study of extended release niacin on atherosclerosis progression in secondary prevention patients treated with statins.
Circulation, 110 (2004), pp. 3512-3517
H.B.. Rubins, S.J. Robins, D. Collins, C.L. Fye, J.W. Anderson, M.B. Elam, et al.
Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group.
N Engl J Med, 341 (1999), pp. 410-418
A. Keech, R.J. Simes, P. Barter, J. Best, R. Scott, M.R. Taskinen, et al.
Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 3 diabetes mellitus (the FIELD study): randomised controlled trial.
Lancet, 366 (2005), pp. 1849-1861
R.C. Turner, H. Millns, H.A. Neil, I.M. Stratton, S.E. Manley, D.R. Matthews, et al.
Risk factors for coronary artery disease in noninsulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23).
BMJ, 316 (1998), pp. 823-828
L.A. Leiter, J. Betteridge, A.R. Chacra, A. Chait, E. Ferrannini, S.M. Haffner, on behalf of the AUDIT Study Steering Committee. AUDIT study, et al.
Evidence of global undertreatment of dyslipidaemia in patients with type 2 diabetes mellitus.
Br J Diabetes Vasc Dis, 6 (2006), pp. 31-40
F.J. García Ruiz, A. Marín Ibáñez, F. Pérez-Jiménez, X. Pinto, G. Nocea, C.. Ahumada, REALITY Study Group, et al.
The REALITY Study.
Pharmacoeconomics., 22 (2004), pp. S1-S12
E. Van Ganse, L. Laforest, E. Alemao, G. Davies, S. Gutkin, D. Yin.
Lipid modifying therapy and attainment of cholesterol goals in Europe: the Return on Expenditure Achieved for Lipid Therapy (REALITY) study.
Curr Med Res Opin, 21 (2005), pp. 1389-1399
F. Díaz de Rojas, T. De Frutos, A. Ponte, J. Mateos Chacón, G.C. Vitale, for the PRI NCEPS Investigators. Coronary Heart Disease and Dyslipidemia.
A Cross-Sectional Evaluation of Prevalence Current Treatment, and Clinical Control in a Large Cohort of Spanish High-Risk Patients: The PRI NCEPS Study.
Prev Cardiol, 12 (2009), pp. 65-71
A. De la Peña Fernández, B. Roca Villanueva, I. Cuende Melero, J.R. Calabuig Alborch, J. Montes Santiago, M. Muñoz Rodríguez, et al.
Effect of a global intervention in the integral control of multiple risk factors in patients at high or very high cardiovascular risk CIFARC 2 project.
Rev Clin Esp, 203 (2007), pp. 112-120
B. Lahoz-Rallo, M. Blanco-González, I. Casas-Ciria, J.A. Marín-Andrade, J.C. Méndez-Segovia, G. Moratalla-Rodríguez, et al.
Cardiovascular disease risk in subjects with type 2 diabetes mellitus in a population in southern Spain.
Diabetes Res Clin Pract, 76 (2007), pp. 436-444
P.M. Kearney, L. Blackwell, R. Collins, A. Keech, J. Simes, R. Peto, Cholesterol Treatment Trialists’ (CTT) Collaborators, et al.
Efficacy of cholesterol-lowering treatment in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis.
C.P. Cannon, E. Braunwald, C.H. McCabe, D.J. Rader, J.L. Rouleau, R. Belder, et al.
Intensive versus moderate lipid lowering with statins after acute coronary syndromes.
N Engl J Med, 350 (2004), pp. 1495-1504
J. Shepherd, P. Barter, R. Carmena, P. Deedwania, J.C. Fruchart, S. Haffner, et al.
Effect of lowering LDL Cholesterol Substantially Below Currently Recommended Levels in Patients with Coronary Heart Diseaseand Diabetes The Treating to New Targets (TNT) study.
Diabetes Care, 29 (2006), pp. 1220-1226
R.J. Thomas, P.J. Palumbo, L.J. Melton, V.L. Roger, J. Ransom, P.C. O’Brien, et al.
Trends in the mortality burden associated with diabetes mellitus: a population-based study in Rochester Minn, 1970–1994.
Arch Intern Med, 163 (2003), pp. 445-451
K. Kotseva, D. Wood, G. De Backer, D. De Bacquer, K. Pyörälä, U. Keil, EURO ASPIR E Study Group.
Cardiovascular prevention guidelines in daily practice: a comparison of EURO ASPIR E I, II , and III surveys in eight European countries.
L. Álvarez-Sala, C. Suárez, T. Mantilla, J. Franch, L.M. Ruilope, J.R. Banegas, et al.
Estudio PREVENCAT: control de los factores de riesgo cardiovascular en Atención Primaria.
Med Clin (Barc), 124 (2005), pp. 406-410
Eficacia del control de los factores de riesgo cardiovascular en la población con diabetes tipo 2 de la provincia de Ciudad Real.
Rev Clin Esp, 205 (2005), pp. 218-222
A. De la Peña, C. Suárez, I. Cuende, M. Muñoz, J. Garre, M. Camafort, et al.
Control integral de los factores de riesgo cardiovascular en pacientes de alto y muy alto riesgo cardiovascular en España Proyecto CIFARC.
Med Clin (Barc), 124 (2005), pp. 44-49
D.M. Mann, J.P. Allegrante, S. Natarajan, E.A. Halm, M. Charlson.
Predictors of adherence to statins for primary prevention.
Cardiovasc Drugs Ther, 21 (2007), pp. 311-316
L. Casebeer, C. Huber, N. Bennett, R. Shillman, M. Abdolrasulnia, G.D. Salinas, et al.
Improving the physician-patient cardiovascular risk dialogue to improve statin adherence.
BMC Fam Pract, 10 (2009), pp. 48
W.C. Hsu.
Consequences of delaying progression to optimal therapy in patients with type 2 diabetes not achieving glycemic goals.
South Med J, 102 (2009), pp. 67-76
K.J. Krobot, D.D. Yin, E. Alemao, E. Steinhagen-Thiessen.
Real-world effectiveness of lipid-lowering therapy in male and female outpatients with coronary heart disease: relation to pretreatment low-density lipoprotein-cholesterol, pre-treatment coronary heart disease risk, and other factors.
Eur J Cardiovasc Prev Rehabil, 12 (2005), pp. 37-45
D.D. Walters.
Safety of high-dose atorvastatin therapy.
Am J Cardiol., 96 (2005), pp. 69F-75F
V.G. Athyros, A.A. Papageorgou, B.R. Merouris, V.V. Athyrou, A.N. Symeonidis, E.O. Basayannis, et al.
Treatment with atorvastatin to the National Cholesterol Educational Program goal versus usual care in secondary heart disease prevention: the GR Eek Atorvastatin and Coronary-heart-disease Evaluation (GR EACE) study.
Curr Med Res Opin, 18 (2002), pp. 220-228
L.A. Leiter, P. Martineau, E. de Teresa, C. Farsang, A. Gaw, G. Gensini, et al.
How to reach LDL targets quickly in patients with diabetes or metabolic syndrome.
J Fam Pract, 57 (2008), pp. 661-668
P. Alagona, L.D.L. Beyond.
cholesterol: the role of elevated triglycerides and low HDL cholesterol in residual CVD risk remaining after statin therapy.
Am J Manag Care, 15 (2009), pp. S65-S73
P.J. Barter, A.M. Gotto, J.C. LaRosa, J. Maroni, M. Szarek, S.M. Grundy, Treating to New Targets Investigators, et al.
HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events.
N Engl J Med, 357 (2007), pp. 1301-1310
M. Miller, C.P. Cannon, S.A. Murphy, J. Qin, K.K. Ray, E. Braundwald.
PRO VE IT-TIMI 22 Investigators Impact of triglyceride levels beyond low-density lipoprotein cholesterol after acute coronary syndrome in the PRO VE IT-TIMI 22 trial.
J Am Coll Cardiol, 51 (2008), pp. 724-730
J.D. Brunzell, M. Davidson, C.D. Furberg, R.B. Goldberg, B.V. Howard, J.H. Stein, et al.
American Diabetes Association;American College of Cardiology Foundation. Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation.
Diabetes Care, 31 (2008), pp. 811-822
J.C. Fruchart, F.M. Sacks, M.P. Hermans, G. Assmann, W.V. Brown, R. Ceska, et al.
The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia.
Am J Cardiol, 102 (2008), pp. 1K-34K
A.A. Alsheikh-Ali, J.L. Lin, P. Abourjaily, D. Ahearn, J.T. Kuvin, R.H. Karas.
Extent to which accepted serum lipid goals are achieved in a contemporary general medical population with coronary heart disease risk equivalents.
Am J Cardiol, 98 (2006), pp. 1231-1233
Copyright © 2011. Sociedad Española de Endocrinología y Nutrición
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos