Despite guideline changes, statin use unchanged or lower in patients with diabetes

Issue: August 2016

NEW ORLEANS — The rate of statin use in adults with diabetes has remained steady or declined since 2014, according to findings presented at the National Lipid Association Scientific Sessions.

“There is enough evidence that statins decrease CVD outcomes in patients with diabetes. Nevertheless, statins remain underused. In real life setting, there could be multiple factors that could be preventing a wide adoption of statin use among endocrinologists and [primary care physicians],” Joanna Mitri, MD, MS, research associate, Section on Clinical, Behavioral and Outcomes Research, Lipid Clinic, Adult Diabetes Section, Joslin Diabetes Center, Boston, said in an interview with Cardiology Today.

Joanna Mitri

The 2013 American College of Cardiology/American Heart Association Guidelines on the Treatment of Blood Cholesterol recommend statin therapy for patients aged 40 to 75 years with diabetes and LDL 70 mg/dL. The American Diabetes Association guidelines were updated to match that recommendation. The NLA guidelines updated in 2014 recommend statins for patients with diabetes who have LDL 100 mg/dL and one or no risk factors; LDL 70 mg/dL and two or more risk factors; or LDL 70 mg/dL and evidence of end-organ damage.

Mitri and colleagues investigated whether the guideline changes had an impact on prescribing patterns of statins for patients with diabetes.

“Despite universal agreement on statin use in diabetes with the new and updated guidelines, this real-life cross-sectional study failed to show that statin use has increased, at least in this large population that we studied,” Mitri said in an interview.

The cross-sectional study included 47,661 patients from 77 practices. The researchers compared those seen before 2014 (n = 38,611; 43% men; median age, 59 years; median LDL, 86 mg/dL) with those seen after 2014 (n = 9,050; 46% men; median age, 64 years; median LDL, 76 mg/dL).

The proportion of statin use was 67% in the pre-2014 group and 69% in the post-2014 group.

When Mitri and colleagues conducted a multivariable analysis adjusted for age and sex, statin use was lower in the post-2014 group among those with LDL < 70 mg/dL (OR = 0.77; 95% CI, 0.71-0.85), unchanged in those with LDL 70 mg/dL to 100 mg/dL (OR = 1.02; 95% CI, 0.93-1.11) and lower in those with LDL 100 mg/dL (OR = 0.89; 95% CI, 0.81-0.97).

When the researchers conducted a multivariable analysis adjusted for LDL level and sex, statin use was unchanged in those aged younger than 40 years (OR = 0.88; 95% CI, 0.71-1.01), lower in those aged 40 to 75 years (OR = 0.91; 95% CI, 0.86-0.96) and lower in those aged older than 75 years (OR = 0.72; 95% CI, 0.61-0.86).

“There are many factors that could be contributing to statin underuse,” Mitri told Cardiology Today. “In my experience, I sometimes find it easier to convince patients to take insulin than to take a statin. Discussion between providers and patients is key. There are tools to facilitate the clinician-patient discussion. For example, beside the guidance of the ACC/AHA guidelines, the ACC Statin Intolerance App facilitates the discussion and includes questions to evaluate muscle-related symptoms, as well as a drug comparison tool and potential drug-drug interactions. I think that we should be doing a better job prescribing statins in diabetes, but also we should be able to study and identify factors that are preventing optimal use of statins, and how best to address those factors, whether they are patient-related or provider-related.” – by Erik Swain

Reference:

Mitri J, et al. Abstract 113. Presented at: National Lipid Association Scientific Sessions; May 19-22, 2016; New Orleans.

For more information:

Joanna Mitri, MD, can be reached at 1 Joslin Place, #239, Boston, MA 02215; email: Joanna.mitri@joslin.harvard.edu.

Disclosure: Mitri reports no relevant financial disclosures.