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Statin use low for many patients with diabetes at risk for CVD
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Prescriptions for statin therapy that could lower risk for MI, stroke and mortality were not written for patients with diabetes considered high risk for CVD in nearly 40% of cases, according to a research letter published in the Journal of the American College of Cardiology.
Researchers analyzed data from 215,193 patients (582,048 encounters) aged 40 to 75 years with diabetes and no CVD from 204 cardiology practices between May 2008 and October 2013 from the PINNACLE registry. In that cohort, statins were prescribed for 61.6% of the patients.
The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends that, unless contraindicated, statin therapy should be used in patients aged 40 to 75 years with diabetes and LDL of at least 70 mg/dL to prevent CVD. The American Diabetes Association recommends a statin be used by patients aged 40 years or older with diabetes, no matter their baseline LDL or CVD status.
Salim Virani
“Patients with diabetes, including those without established [CVD], have a very high risk of having [MI] or stroke, and they are also more likely to die of one compared to people without diabetes,” Salim Virani, MD, PhD, cardiologist at the Michael E. DeBakey Veterans Affairs and Medical Center and associate professor at Baylor College of Medicine, Houston, said in a press release. “In this study, we found 38% of patients with diabetes were not on a statin, which can be lifesaving.”
The researchers found that compared with patients not receiving statins, those taking statins displayed a higher prevalence of CV risk factors, were more likely to be undergoing non-statin therapy to lower cholesterol (28% vs. 13%) and also had lower mean LDL levels (90 mg/dL vs. 103 mg/dL).
Prescription levels by practice varied widely. Adjusted median rate ratio for statin use was 1.57 (95% CI, 1.52-1.61), which the researchers wrote suggested a practice-level variation of 57% in statin use for two patients otherwise similar. Adjusted median rate ratio for attaining LDL levels less than 100 mg/dL was 1.47 (95% CI, 1.42-1.5).
The researchers wrote that, in a Veterans Affairs study of 130 primary-care facilities, statins were prescribed for 61% of patients with the same characteristics as the present cohort cohort (median rate ratio = 1.2), “suggesting more consistent care in the [VA] system.
“Such wide variation illustrates the gap between guideline recommendations and real-world practice,” Virani said in the release. “Health care providers manage similar diabetes patients differently. While some variation is OK, what we found is concerning and may ultimately affect clinical outcomes.” – by James Clark
Disclosure: Virani reports serving on the steering committee for the PALM registry sponsored in part by Regeneron and Sanofi without compensation. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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