Conference Diabetic Dyslipidemia 02-12-2019

Cholesterol Treatment Trialists Collaboration statin

Statin reduces the 5-year incidence of major coronary events, coronary revascularization, and stroke by about a fifth per mmol/L reduction in LDL, largely irrespective of initial lipid profile or other baseline characteristics

IMPROVE-IT ezetimabe

Adding a non-statin lipid-modifying agent in concert with a statin improves CV outcomes in addition to enhancing lipid lowering effects

The subset of patients with DM had a higher rate of major vascular events than patients without DM (46 vs. 31%)

 CV mortality, major CV event, or nonfatal stroke:

34.7% ( sim mono ) vs  32.7% (sim + Ezt) (HR 0.94 ;  P=0.016;  NNT 50

FOURIER evolocumab

Evolocumab on a background statin therapy lowered LDL to a median of 30 mg /dL and reduced the risk of cardiovascular events

Patients with ASCVD benefit from the lowering of LDL below current targets

There were reductions of 21 to 27% in the risk of MI, stroke, coronary revascularization

NO effect on cardiovascular mortality

ODYSSEY DM DYSLIPIDEMIA trial

In T2DM and mixed dyslipidemia on maximally tolerated statin, alirocumab showed superiority to UC (Fibrate, niacin,EZT, omeaga3) in non-HDL c reduction and was generally well tolerated

ODYSSEY outcome

alirocumab

Among patients who had a previous ACS and who were receiving high-intensity statin, the risk of recurrent ischemic cardiovascular events was lower among those who received alirocumab than placebo

Prespecified analysis of the ODYSSEY

After a recent ACS, alirocumab treatment targeting an LDL of 0·65–1·30 mmol/L produced twice the absolute reduction in cardiovascular events among patients with diabetes as without diabetes.

Alirocumab treatment did not increase the risk of new-onset diabetes