| Prevalence and treatment of low HDL cholesterol among primary care patients with type 2 diabetes: an unmet challenge for cardiovascular risk reduction. | |
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MedLine Citation:
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PMID: 17327308 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Patients with diabetes remain at high risk for cardiovascular events despite aggressive blood pressure, LDL cholesterol, and blood glucose control. We identified prevalence and predictors of low HDL cholesterol, characterized current lipid therapy, and estimated the theoretical benefit of more effective HDL cholesterol-raising methods among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We analyzed a primary care-based population of patients with type 2 diabetes (n = 7,692) in 12 eastern Massachusetts outpatient practices. We grouped fibrates, niacins, and n-3 fatty acid preparations as nonstatin HDL cholesterol-raising medicines, and we used published studies to estimate the potential benefit of raising HDL cholesterol levels in this population. RESULTS: Nearly half (49.5%) of patients had low HDL cholesterol (<40 mg/dl for men, <50 mg/dl for women). Low HDL cholesterol was independently associated with prevalent cardiovascular disease (CVD), younger age, and higher A1C levels. Nearly two-thirds of patients (63.0%) were prescribed a statin (67.6% of patients below the HDL cholesterol goal, 80.5% of patients with CVD). In contrast, only 7.9% of patients were prescribed a nonstatin HDL cholesterol-raising medication, including 16.4% of patients below the HDL cholesterol goal with CVD. Based on published studies, normalizing low HDL cholesterol in this primary care cohort would correspond to an estimated CVD mortality reduction of 42% in women and 23% in men. CONCLUSIONS: Nearly half of the patients in this large primary care cohort had low HDL cholesterol levels. In contrast to frequent statin use, few patients were prescribed currently available medicines to raise HDL cholesterol. Low HDL cholesterol represents a highly prevalent and potentially modifiable risk factor for CVD prevention in type 2 diabetes. |
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Authors:
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Richard W Grant; James B Meigs |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Diabetes care Volume: 30 ISSN: 1935-5548 ISO Abbreviation: Diabetes Care Publication Date: 2007 Mar |
Date Detail:
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Created Date: 2007-02-28 Completed Date: 2007-04-27 Revised Date: 2011-09-15 |
Medline Journal Info:
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Nlm Unique ID: 7805975 Medline TA: Diabetes Care Country: United States |
Other Details:
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Languages: eng Pagination: 479-84 Citation Subset: IM |
Affiliation:
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General Medicine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. rgrant@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiovascular Diseases / epidemiology, prevention & control Cholesterol, HDL / blood* Cohort Studies Diabetes Mellitus, Type 2 / blood* Diabetic Angiopathies / epidemiology, prevention & control Dyslipidemias / blood*, drug therapy* Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use Male Middle Aged Prevalence |
| Grant Support | |
ID/Acronym/Agency:
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K23 DK067452/DK/NIDDK NIH HHS; K23 DK067452-03/DK/NIDDK NIH HHS; R21 HS015785-01/HS/AHRQ HHS |
| Chemical | |
Reg. No./Substance:
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0/Cholesterol, HDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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