Glycemic Control and Cholesterol Control Attainment following Acute Coronary Syndrome in Patients with Type 2 Diabetes Mellitus Undergoing Percutaneous Coronary Intervention
Tanapol Juntaruk, MD¹, Peeradon Dutsadeevettakul², Phanthaphan Sureeyathanaphat, MD¹,³
Affiliation : ¹ Department of Internal Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; ² Medical student, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; ³ Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Background: Cardiovascular disease (CVD) is a leading cause of mortality and disability in patients with type 2 diabetes mellitus (T2DM), with elevated risks of recurrent cardiovascular events after acute coronary syndrome (ACS). Achieving optimal glycemic and lipid targets, including hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C), is critical for secondary prevention in this high-risk population.
Objective: To assess HbA1c, LDL-C, and non-HDL-C target attainment rates in T2DM patients after percutaneous coronary intervention (PCI) for ACS. Additionally, to evaluate the prevalence of atherogenic dyslipidemia and explores predictive factors influencing target achievement.
Materials and Methods: A retrospective, longitudinal descriptive study was conducted on 420 patients with T2DM who experienced ACS and underwent PCI at Vajira Hospital between January 2017 and December 2021. Data on baseline characteristics, laboratory values, and medication regimens were collected. Target attainment was defined as HbA1c of less than 7%, LDL-C of less than 55 mg/dL with 50% or more reduction, and non-HDL-C of less than 85 mg/dL. Logistic regression analysis identified factors predicting target achievement.
Results: At six months, 76.0% of patients achieved HbA1c of less than 7%, while only 17.6% and 37.6% met LDL-C and non-HDL-C targets, respectively. At twelve months, HbA1c attainment remained high at 76.4%, but LDL-C and non-HDL-C targets were less frequently achieved at 21.4% and 44.0%, respectively. Atherogenic dyslipidemia prevalence decreased from 16.9% at baseline to 12.14% at twelve months. Male gender predicted HbA1c target achievement, while baseline HbA1c, sulfonylurea, and insulin use were negative predictors. Ezetimibe treatment and the civil servant health scheme positively influenced LDL-C target attainment.
Conclusion: Despite high rates of HbA1c target attainment, LDL-C, and non-HDL-C goals were achieved less frequently, highlighting gaps in lipid management in T2DM patients post-ACS. Enhanced strategies for comprehensive secondary prevention, particularly lipid control, are necessary to improve outcomes in this population.
Received 3 March 2025 | Revised 5 January 2026 | Accepted 16 January 2026
DOI: 10.35755/jmedassocthai.2026.2.02808
Keywords : Type 2 diabetes mellitus; Acute coronary syndrome; HbA1c; LDL-C; Non-HDL-C; Secondary prevention; Atherogenic dyslipidemia
