Lipid-lowering therapy and LDL target attainment in type 2 diabetes: trends from the Italian Associations of Medical Diabetologists database.
Antonio Rossi, Davide Masi, Rita Zilich, Fabio Baccetti, Walter Baronti, Pierpaolo Falcetta, Lelio Morviducci, Nicoletta Musacchio, Marco Muselli, Alessandro Ozzello, Enrica Salomone, Damiano Verda, Maria Vezenkova, Riccardo Candido, Paola Ponzani
Author Information
Antonio Rossi: IRCCS Ospedale Galeazzi-Sant'Ambrogio, 20149, Milan, Italy. antonio.rossi1@unimi.it.
Davide Masi: Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy. davide.masi@uniroma1.it.
Rita Zilich: Mix-x SRL, 10015, Ivrea, Italy.
Fabio Baccetti: ASL Nordovest Toscana, Massa Carrara, MS, Italy.
Walter Baronti: Diabetic and Metabolic Diseases Unit, Health Local Unit South-East Tuscany, Grosseto Hospital, Grosseto, Italy.
Pierpaolo Falcetta: Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Via Trivella, 56124, Pisa, Italy.
Lelio Morviducci: Diabetology and Nutrition Unit, Department of Medical Specialities, ASL Roma 1, S. Spirito Hospital, 00193, Rome, Italy.
Nicoletta Musacchio: Associazione Medici Diabetologi, 20156, Milan, Italy.
Marco Muselli: Rulex Innovation Labs, Rulex Inc., 16122, Genoa, Italy.
Alessandro Ozzello: Gruppo Nazionale AI AMD, Bruino, Torino, TO, Italy.
Enrica Salomone: Diabetology and Nutrition Unit, Department of Medical Specialities, ASL Roma 1, S. Spirito Hospital, 00193, Rome, Italy.
BACKGROUND: Hypercholesterolemia is a major cardiovascular risk factor, particularly in individuals with type 2 diabetes (T2DM), where cardiovascular events are more prevalent. Adherence to low-density lipoprotein cholesterol (LDL-c) targets remains suboptimal globally and in Italy. This study evaluates trends in LDL-c target achievement and lipid-lowering treatment with a stratification by cardiovascular risk among Italian patients with type 2 diabetes from 2019 to 2022. METHODS: A cross-sectional analysis was conducted using the AMD Annals database, encompassing over 700,000 patients with T2DM. Patients were categorized by cardiovascular risk levels, LDL-c ranges and therapy types (statins, ezetimibe, PCSK9 inhibitors). Linear trends across the four years were evaluated. RESULTS: The percentage of patients achieving LDL-c targets improved across all risk levels. In very high-risk patients, LDL-c < 55 mg/dL was achieved by 16.3% in 2019, increasing to 23.6% in 2022. High-risk patients achieving LDL-c < 70 mg/dL rose from 20.3 to 26.6% over the same period. Use of PCSK9 inhibitors, particularly in combination with statins, was associated with the highest target achievement rates, reaching 62% in very high-risk patients by 2022. We observed a reduction of moderate-intensity statins use in favor of combination therapies across the four years. Despite this, nearly one-third of patients still had LDL-c levels ≥ 100 mg/dL in 2022. CONCLUSIONS: While LDL-c management in Italian patients with T2DM has improved, significant gaps remain, particularly for very high-risk individuals. Expanding the use of advanced therapies like PCSK9 inhibitors and adhering more closely to guideline-based recommendations are critical to improve cardiovascular risk in this population.
