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Table 2 Treatments required to achieve the LDL-c targets and the expected clinical benefits

From: Cholesterol lowering therapies and achievement of targets for primary and secondary cardiovascular prevention in type 2 diabetes: unmet needs in a large population of outpatients at specialist clinics

LDL-c group

Current therapy

10 yr CVD risk

Mean LDL-c

2016

GLT

2019

GLT

DTT

 %

Treatment needed to reach target

LDL-c red

Expected ARR (95% C.I.)

Expected NNT

(95% C.I.)

Very high risk

 

No Statin (n = 1319; 1.5%)

25%

1.1

√

(√)

50%

Hi-St

0.6

4.3%

30.0

< 1.4

Mi-St (n = 1268; 1.5%)

28%

1.2

√

(√)

28%

Hi-St

0.3

2.8%

46.3

 

Hi-St (n = 4051; 4.7%)

26%

1.1

√

√

–

–

–

–

–

 

Mi-St + Eze (n = 574; 0.7%)

23%

1.1

√

√

–

–

–

–

–

 

Hi-St + Eze (n = 144; 0.2%)

22%

1.2

√

√

–

–

–

–

–

Sub-Total n = 7356; 8.5%

       

1.2 (− 0.2 –2.7)

80 (38 –− 638)

 

No Statin (n = 1992; 2.3%)

25%

1.6

√

 

50%

Hi-St

0.8

5.8%

21.7

1.4–1.8

Mi-St (n = 2470; 2.9%)

25%

1.6

(√)

 

28%

Hi-St

0.5

3.5%

37.0

 

Hi-St (n = 4916; 5.7%)

26%

1.6

√

 

14%

Hi-St + Eze

0.5

3.9%

33.1

 

Mi-St + Eze (n = 710; 0.8%)

26%

1.6

√

 

14%

Hi-St + Eze

0.6

4.5%

28.4

 

Hi-St + Eze (n = 153; 0.2%)

26%

1.6

√

 

14%

Hi-St + Eze + PCSK9i

0.9

6.6%

19.0

Sub-Total n = 10,241; 11.9%

       

4.3 (3.1–5.4)

24 (19 – 33)

 

No Statin (n = 7592; 8.8%)

25%

2.2

  

50%

Hi-St

1.1

7.6%

16.6

1.8–2.6

Mi-St (n = 5650; 6.5%)

25%

2.2

  

28%

Hi-St

0.6

4.4%

28.8

 

Hi-St (n = 8993; 10.4%)

25%

2.2

  

35%

Hi-St + Eze + PCSK9i

1.5

9.9%

12.6

 

Mi-St + Eze (n = 1150; 1.3%)

24%

2.2

  

35%

Hi-St + Eze

0.8

5.4%

23.4

 

Hi-St + Eze (n = 255; 0.3%)

26%

2.2

  

36%

Hi-St + Eze + PCSK9i

1.2

8.5%

14.7

Sub-Total n = 23,640; 27.4%

       

7.6 (6.9–8.3)

13 (12 –15)

 

No Statin (n = 11,322; 13.1%)

25%

3.2

  

57%

Hi-St + Eze

2.1

12.5%

9.7

>2.6

Mi-St (n = 3964; 4.6%)

24%

3.2

  

57%

Hi-St + Eze + PCSK9i

2.6

13.8%

8.7

 

Hi-St (n = 5715; 6.6%)

26%

3.3

  

58%

Hi-St + Eze + PCSK9i

2.3

13.8%

8.7

 

Mi-St + Eze (n = 892; 1.0%)

24%

3.5

  

60%

Hi-St + Eze + PCSK9i

2.5

13.3%

9.0

 

Hi-St + Eze (n = 227; 0.3%)

28%

3.5

  

60%

Hi-St + Eze + PCSK9i

2.0

13.1%

9.3

Sub-Total n = 22,120; 25.6%

       

13.1 (12.4 - 13.8)

7.6 (7.2 - 8.1)

Total very-high risk n = 63,357; 73.4%

25%

      

8.3 (7.8–8.7)

12.1 (11.5–12.8)

High risk

         
 

No Statin (n = 341; 0.4%)

19%

1.1

√

(√)

50%

Hi-St

0.6

3.1%

32.0

< 1.4

Mi-St (n = 302; 0.4%)

18%

1.2

√

(√)

28%

Hi-St

0.3

1.8%

56.2

 

Hi-St (n = 943; 1.1%)

18%

1.2

√

√

–

–

–

–

–

 

Mi-St + Eze (n = 109; 0.1%)

15%

1.1

√

√

–

–

–

–

–

 

Hi-St + Eze (n = 30; 0.0%)

14%

1.1

√

√

–

–

–

–

–

Sub-Total n = 1725; 2.0%

       

0.9 −1.6–3.5)

107 (29– −62)

 

No Statin (n = 588; 0.7%)

17%

1.6

√

(√)

50%

Hi-St

0.8

4.0%

25.1

1.4–1.8

Mi-St (n = 705; 0.8%)

17%

1.6

√

(√)

28%

Hi-St

0.5

2.3%

42.6

 

Hi-St (n = 1421; 1.6%)

20%

1.6

√

√

–

–

–

–

–

 

Mi-St + Eze (n = 163; 0.2%)

15%

1.6

√

√

–

–

–

–

–

 

Hi-St + Eze (n = 27; 0.0%)

26%

1.6

√

√

–

–

–

–

–

Sub-Total n = 2904; 3.4%

       

1.4 (− 0.6 –3.3)

73 (30 – −173)

 

No Statin (n = 2964; 3.4%)

19%

2.3

√

 

50%

Hi-St

1.1

5.7%

17.5

1.8–2.6

Mi-St (n = 2045; 2.4%)

18%

2.2

(√)

 

28%

Hi-St

0.6

3.3%

30.4

 

Hi-St (n = 2936; 3.4%)

19%

2.2

√

 

18%

Hi-St + Eze

0.7

3.7%

27.4

 

Mi-St + Eze (n = 302; 0.4%)

17%

2.2

√

 

18%

Hi-St + Eze

0.8

3.8%

26.7

 

Hi-St + Eze (n = 66; 0.1%)

18%

2.2

√

 

19%

Hi-St + Eze + PCSK9i

1.3

6.0%

16.5

Sub-Total n = 8313; 9.6%

       

4.3 (3.2–5.4)

23 (18–31)

 

No Statin (n = 5302; 6.1%)

19%

3.3

  

50%

Hi-St

1.6

7.9%

12.7

>2.6

Mi-St (n = 1806; 2.1%)

17%

3.3

  

45%

Hi-St + Eze

1.6

7.2%

13.9

 

Hi-St (n = 2275; 2.6%)

18%

3.3

  

47%

Hi-St + Eze + PCSK9i

2.3

9.8%

10.2

 

Mi-St + Eze (n = 288; 0.3%)

16%

3.4

  

48%

Hi-St + Eze + PCSK9i

2.5

9.2%

10.9

 

Hi-St + Eze (n = 70; 0.1%)

15%

3.4

  

48%

Hi-St + Eze + PCSK9i

2.0

7.2%

14.0

Sub-Total n = 9741; 11.3%

       

8.2 (7.2–9.2)

12 (11–14)

Total high risk n = 22,683; 26.3%

18%

      

5.4 (4.7–6.0)

18.7 (16.6–21.3)

Total n = 86,040; 99.7%

24%

 

35%

14%

   

7.5% (7.1–7.9)

13.4 (12.7–4.1)

  1. (√): Achievement of targets according to 2016 or 2019 Guidelines for absolute levels but not for expected  % reduction from untreated levels
  2. MI-St Moderate Statin, Hi-St High-Intensity Statin, Eze Ezetimibe, PCSK9i Proportein convertase subtilisin/kexin type 9 inhibitors, CVD risk risk score for major cardiovascular (CVD) events over 10 years, GLT Guidelines Targets, DTT distance to targets from mean LDL-c levels (in  %), LDL-c red Expected absolute LDL-c reduction estimated as the product of current LDL-c levels with expected  % reduction with new treatments). Expected ARR: Absolute Risk Reduction (estimated as current absolute CVD risk * RRR, where Relative risk Reduction has been estimated according to the expected absolute LDL-c reduction (i.e. 28% per each mmol/l reduction in LDL-c). NNT: number of subjects needed to be treated to avoid one CVD events over 10 years. 1 mmol/L LDL-c = 38.67 mg/dl
  3. The population was stratified by CVD risk groups, LDL-cholesterol levels (mmol/l) and current treatments
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Cardiovascular Diabetology

ISSN: 1475-2840