+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn

+ Translate
+ Recently Requested

Better lipid target achievement for secondary prevention through disease management programs for diabetes mellitus and coronary heart disease in clinical practice in Germany

Better lipid target achievement for secondary prevention through disease management programs for diabetes mellitus and coronary heart disease in clinical practice in Germany

Current Medical Research and Opinion 32(3): 417-426

Disease management programs (DMP) for diabetes mellitus (DM) or coronary heart disease (CHD) address the treatment of lipid disorders. The current registry aimed to compare drug utilization, lipid lowering effects and further outcomes of outpatients at high cardiovascular risk in DMP for DM or CHD compared to patients in routine care (no-DMP). This was a prospective non-interventional registry with a 1 year follow-up which enrolled consecutive patients with known DM and/or any vascular disease on simvastatin 40 mg monotherapy, to document lipid target achievement in clinical practice in Germany according to existing guidelines. Drug use (maintenance, add-on, switch, discontinuation) and other components of care were upon the discretion of the treating physician. Of a total of 12,154 patients (mean age 65.8 years, 61.2% males), 3273 were in DMP CHD, 3265 in DMP DM and 1760 in DMP CHD + DM. In DMP patients compared to no-DMP patients, comorbidities/risk factors were more frequent. More patients in the DMP groups attained the target level of low density lipoprotein (LDL-C) <70 mg/dl (1.8 mmol/l) at baseline (8.5% DMP vs. 5.7% no-DMP), at 6 month (10.3% vs. 7.4%) and 12 month follow-up (10.1% vs. 7.1%). Cholesterol absorption inhibitors were added in 16% of the patients at the end of the baseline or at the follow-up visits, while statin treatment (including mean dose) remained largely unchanged. Target achievement rates were highest for all time points in the DMP CHD + DM group. With respect to limitations, this study was restricted to lipid disorders as qualifying diagnosis and simvastatin as qualifying treatment, which is a potential cause of selection bias. Information on non-pharmacological measures was not collected, and the 12-month follow-up period was relatively short. Patients in DMP compared to those not in DMP achieved better LDL-C lowering and higher control rates, but overall lipid target achievement rates need to be improved. Longer-term observations are needed to corroborate these findings.

(PDF emailed within 0-6 h: $19.90)

Accession: 057293681

Download citation: RISBibTeXText

PMID: 26568400

DOI: 10.1185/03007995.2015.1120715

Related references

Management of coronary artery disease in patients with and without diabetes mellitus. Acute management reasonable but secondary prevention unacceptably poor: a report from the Euro Heart Survey on Diabetes and the Heart. European Journal of Cardiovascular Prevention and Rehabilitation 14(1): 28-36, 2007

Evidence-based goals versus achievement in clinical practice in secondary prevention of coronary heart disease: Findings in EUROASPIRE II. Atherosclerosis Supplements 2(4): 13-17, 2002

The effectiveness of German disease management programs (DMPs) in patients with type 2 diabetes mellitus and coronary heart disease: results from an observational longitudinal study. Diabetology and Metabolic Syndrome 7: 77, 2015

Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary heart disease: baseline results from the STABILITY study. European Journal of Preventive Cardiology 20(4): 678-685, 2014

Cultural sensitivity in nutrition education for the prevention and management of diabetes mellitus and coronary heart disease. Journal of the New Zealand Dietetic Association 44(1): 27-29, 1990

Adherence to clinical guidelines in the prevention of coronary heart disease in type II diabetes mellitus. Pharmacy World and Science 30(1): 120-127, 2007

Secondary prevention in coronary heart disease. Payment for chronic disease management should include coronary heart disease. Bmj 317(7172): 1592, 1998

Secondary prevention of coronary heart disease. Recommendations of the Workshop of the International Society and Federation of Cardiology on the Secondary Prevention of Coronary Heart Disease. Titisee (German Federal Republic), 21-14 October 1983. Cardiologia 29(9-10): 459-474, 1984

Secondary prevention of coronary artery disease in hospital practice over the decade 1996-2006. Results of the Cracovian Program for Secondary Prevention of Ischaemic Heart Disease and Polish parts of the EUROASPIRE II and EUROASPIRE III surveys. Kardiologia Polska 67(8a): 970-977, 2010

Clinical significance of primary and secondary prevention trials with lipid-lowering therapy against coronary heart disease. Nihon Rinsho. Japanese Journal of Clinical Medicine 59 Suppl 3: 365-373, 2001

A case from practice (347). Diabetes mellitus type II--coronary heart disease with status after anterior wall infarct and PTCA 1994--secondary erectile dysfunction. Praxis 85(17): 574-576, 1996

Overweight and obesity: a major challenge for coronary heart disease secondary prevention in clinical practice in Europe. European Heart Journal 21(10): 808-813, 2000

Secondary prevention of coronary heart disease in clinical practice: special considerations for intensified lifestyle modification. European Journal of Clinical Investigation 29(5): 365-368, 1999

Clinical immune modulating influences of polyoxidonium on secondary immunodeficiency in patients with coronary heart disease associated with diabetes mellitus type 2. Immunologiya 29(1): 44-50, 2008

Secondary prevention in coronary heart disease: goal achievement and drug prescribing. Pharmacy World and Science 27(6): 472-474, 2005