title: Better lipid target achievement for secondary prevention through disease management programs for diabetes mellitus and coronary heart disease in clinical practice in Germany.
abstract: OBJECTIVE
  Disease management programs (DMP) for diabetes mellitus (DM) or coronary heart disease (CHD) address the treatment of lipid disorders. The current registry aimed to compare drug utilization, lipid lowering effects and further outcomes of outpatients at high cardiovascular risk in DMP for DM or CHD compared to patients in routine care (no-DMP).
  
  
  METHODS
  This was a prospective non-interventional registry with a 1 year follow-up which enrolled consecutive patients with known DM and/or any vascular disease on simvastatin 40 mg monotherapy, to document lipid target achievement in clinical practice in Germany according to existing guidelines. Drug use (maintenance, add-on, switch, discontinuation) and other components of care were upon the discretion of the treating physician.
  
  
  RESULTS
  Of a total of 12,154 patients (mean age 65.8 years, 61.2% males), 3273 were in DMP CHD, 3265 in DMP DM and 1760 in DMP CHD + DM. In DMP patients compared to no-DMP patients, comorbidities/risk factors were more frequent. More patients in the DMP groups attained the target level of low density lipoprotein (LDL-C) <70 mg/dl (1.8 mmol/l) at baseline (8.5% DMP vs. 5.7% no-DMP), at 6 month (10.3% vs. 7.4%) and 12 month follow-up (10.1% vs. 7.1%). Cholesterol absorption inhibitors were added in 16% of the patients at the end of the baseline or at the follow-up visits, while statin treatment (including mean dose) remained largely unchanged. Target achievement rates were highest for all time points in the DMP CHD + DM group. With respect to limitations, this study was restricted to lipid disorders as qualifying diagnosis and simvastatin as qualifying treatment, which is a potential cause of selection bias. Information on non-pharmacological measures was not collected, and the 12-month follow-up period was relatively short.
  
  
  CONCLUSIONS
  Patients in DMP compared to those not in DMP achieved better LDL-C lowering and higher control rates, but overall lipid target achievement rates need to be improved. Longer-term observations are needed to corroborate these findings.
authors.affiliation: a a Herzzentrum Ludwigshafen, Med. Klinik B und Stiftung Institut für Herzinfarktforschung , Ludwigshafen , Germany.
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
authors.affiliation: b b Matthias-Claudius-Strasse , Henstedt-Ulzburg , Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Sonntag
authors.affiliation: c c Medical Department, MSD Sharp & Dohme GmbH , Haar , Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Jannowitz
authors.affiliation: d d Werderstrasse , Mannheim , Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Weizel
authors.affiliation: c c Medical Department, MSD Sharp & Dohme GmbH , Haar , Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Karmann
authors.affiliation: e e UKGM Klinikum Marburg, Philipps-Universität Marburg , Marburg/Lahn , Germany.
authors.forename: Juergen R
authors.initials: JR
authors.lastname: Schaefer
authors.affiliation: f f Institut für Klinische Pharmakologie, Technische Universität , Dresden , Germany.
authors.forename: David
authors.initials: D
authors.lastname: Pittrow
authors.affiliation: g g Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg , Bad Krozingen , Germany.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Hildemann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D055502:Secondary Prevention; D019821:Simvastatin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D019821:Simvastatin
keywords: Cardiovascular disease; Coronary heart disease; Disease management program; Dyslipidemia; Observation; Risk factors