The efficiency of dyslipidemia control in real clinical practice and the possibilities of its correction in patients with coronary heart disease and diabetes mellitus in the long-term use of simvastatin
Objective: To show the efficiency of dyslipidemia control in patients with coronary heart disease (CHD) and diabetes mellitus (DM) in real outpatient clinical practice and the possibilities of its correction in the long-term use of simvastatin (simvastatin forte 40 mg) in one of the Nizhny Novgorod polyclinics. Subjects and methods. The efficiency of lipid profile control was analyzed in a sample from the entire dispensary group of patients with DM (n = 713). Patients at highest cardiovascular risk were selected from the dispensary group and included into a group of CHD and DM. There were a total of 461 (64.7 %) such patients. Forty-three patients were identified in this group, who were matched for baseline systolic and dia- stolic blood pressures, age, gender, and DM duration and were found to have significant hypercholesterolemia. Simvastatin forte 40 mg was prescribed to these patients at their outpatient visit. During a year, the patient made 6 visits to his/her physician (5 visits at 6-werk intervals and the sixth visit by the end of the follow-up year). The dose of simvastatin was unchanged throughout the study. Results. In the entire dispensary group, 64.7 % of the patients had a concurrence of CHD and DM. This group of patients was at high risk for dyslipidemia. In this group, 2.8 % had a total cholesterol (TC) level of ≤ 3.5 mmol/l; 4.7 % had a low-density lipoprotein cholesterol (LDL-C) level of < 1.8 mmol/l. The total lipid profile was analyzed in only 6.3% of the patients from the entire dispensary group. 28.6 % of the patients with type 1 DM and 21.3% of those with CHD and type 2 DM took statins. Fifty-two week therapy with simvastatin forte 40 mg showed its high efficiency in real practice in decreasing the levels of atherogenic lipids and lipoproteins: TC by 27.6 % (p < 0.001), LDL-C by 36.9 % (p < 0.001), and triglycerides by 34.3 % (p < 0.001) with antiatherogenic high-density lipoprotein cholesterol elevation by 15.2 % (p < 0,001). Simvastatin forte therapy was well tolerated: the mean values of liver enzymes and the activity of creatine phosphokinase remained within the normal range. After one-year simvastatin forte therapy, the blood concentration of glucose decreased by 10.5%. Conclusion. Simvastatin forte (40 mg/day) demonstrated good hypolipidemic efficacy, tolerability, and high safety profile in patients with CHD and DM.