Metas lipídicas en pacientes diabéticos. Implicaciones clínicas luego de aplicar una nueva fórmula para el cálculo del colesterol-LDL

espanolIntroduccion: Existen claras recomendaciones para el manejo lipidico en los diabeticos. Una nueva formula para el calculo del C-LDL mejoraria la imprecision de la formula de Friedewald. Objetivos: Analizar el uso de estatinas y el cumplimiento de las metas lipidicas en pacientes diabeticos, evaluando las consecuencias de aplicar una nueva formula para el calculo del C-LDL. Metodos: Estudio descriptivo, transversal y multicentrico. Se incluyeron diabeticos tipo 2 mayores de 18 anos. El C-LDL se calculo con la formula clasica (Friedewald) y la nueva formula. Se siguieron las recomendaciones del documento de posicion para el uso adecuado de estatinas (Sociedad Argentina de Cardiologia). Resultados: Se incluyeron 528 pacientes. En prevencion secundaria, el 77,2% recibio estatinas (23,4% alta intensidad). El 36,6% y el 36,0% alcanzaron la meta de C-LDL menor a 70 mg/dL y de C-noHDL inferior a 100 mg/dL, respectivamente. El 20,8% de los pacientes con un C-LDL menor de 70 mg/dL (Friedewald) salio de meta al aplicar la nueva formula. En los pacientes en prevencion primaria con factores de riesgo o dano de organo blanco, el 62,2% recibio estatinas (14,7% alta intensidad). El 20,9% y el 20,4% alcanzaron la meta de C-LDL menor a 70 mg/dL y de C-noHDL inferior a 100 mg/dL. El 27,7% de los pacientes con un C-LDL menor de 70 mg/dL (Friedewald) salio de meta al aplicar la nueva formula. A mayor nivel de trigliceridos, mas pacientes salieron de meta de C-LDL con la nueva formula. Conclusion: El cumplimiento de las metas lipidicas y el uso adecuado de estatinas en esta poblacion fue deficiente. Aplicar la nueva formula de C-LDL optimizo la evaluacion de estos pacientes. EnglishBackground: There are clear recommendations for lipid management in diabetic patients. A new formula for the calculation of LDL-cholesterol (LDL-C) would improve the inaccuracy of the Friedewald formula. Objectives: The aim of this study was to analyze the use of statins and the fulfillment of lipid goals in diabetic patients, evaluating the consequences of applying a new formula for LDL-C calculation. Methods: This was a descriptive, cross-sectional, multicenter study including type 2 diabetic patients over 18 years of age. LDL-C was calculated using the classic Friedewald formula and the new formula. Recommendations of the position document for the appropriate use of statins from the Argentine Society of Cardiology were followed. Results: A total of 528 patients were included in the study. In secondary prevention, 77.2% of patients received statins (23.4% high-intensity statins) and 36.6% and 36.0% of these patients achieved the goals of LDL-C below 70% mg/dl and non-HDL-C below 100 mg/dl, respectively. In 20.8% of patients with LDL-C below 70 mg/dl according to the Friedewald formula, this goal was not attained when the new formula was applied. In primary prevention, 62.2% patients with risk factors or white organ damage received statins (14.7% high-intensity statins) and 20.9% and 20.4% achieved the goals of LDL-C below 70% mg/dl and non-HDL-C below 100 mg/dl. In 27.7% of patients with LDL-C below 70 mg/dl using the Friedewald formula, this goal was not reached when applying the new formula. More patients did not achieve the LDL-C goal with the new formula when the triglyceride level was higher. Conclusion: In this population, the appropriate use of statins and the fulfillment of lipid goals were poor. Applying the new LDL-C formula optimized the evaluation of these patients.