Reaching target lipid levels and the natural history of diabetes mellitus in patients surviving acute coronary syndrome: A retrospective cohort study from a tertiary care outpatient clinic

Background: Despite the known benefits of lipid-lowering therapy, only a minority of high-risk subjects are reaching defined lipid targets. Impaired fasting glucose and diabetes mellitus are associated with poor short- and long-term outcomes in subjects with acute coronary syndromes (ACSs).

Objectives: To determine the proportion of patients surviving five years of ACS who met recommended lipid targets, and to determine the proportion of subjects with impaired fasting glucose and diabetes mellitus.

Methods: A retrospective cohort study of 101 patients surviving at least five years of ACS and having at least three visits to a tertiary care outpatient clinic was conducted. Fasting lipid and glucose profiles were extracted from records of each patient's visit.

Results: The mean change in lipid values between visits 1 and 3 was significant. Only 34% of the patients met the target level for low-density lipoprotein cholesterol, and 63% met the target ratio for total cholesterol to high-density lipoprotein cholesterol at visit 3. The mean glucose level increased, and the proportion of subjects with diabetes mellitus increased (P<0.0001 between visits 1 and 3). The predictors for diabetes mellitus at visit 3 were a high lipid level and a high fasting glucose level at visit 1 (P<0.05 for both).

Conclusions: Despite a significant improvement in mean lipid levels in the patients surviving at least five years of ACS, the majority of high-risk patients are not meeting defined lipid levels for low-density lipoprotein cholesterol. The mean fasting glucose level and the proportion of subjects with diabetes mellitus significantly increased during follow-up. Patients with higher glucose and lipid levels at baseline were found to be associated with a higher risk for new diabetes mellitus.