title: 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.
abstract: 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).
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Medicine I, Faculty Hospital Královské Vinohrady, 3rd Faculty of Medicine, Charles University.
authors.forename: Filip
authors.initials: F
authors.lastname: Málek
authors.forename: Ing Jan
authors.initials: IJ
authors.lastname: Dvorák
authors.forename: Hana
authors.initials: H
authors.lastname: Strieborná
authors.forename: Veronika
authors.initials: V
authors.lastname: Kocvarová
authors.forename: Rudolf
authors.initials: R
authors.lastname: Spacek