Statins reduce CVD, death in low-risk patients with type 2 diabetes
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The use of statins in patients with recently diagnosed type 2 diabetes reduced incidence of CVD and death, particularly in older and adherent patients, according to a study.
The retrospective study included 77,170 patients in Denmark aged 40 to 89 years diagnosed with type 2 diabetes from 2005 to 2011 still living 18 months after diagnosis. Patients were excluded for diagnosis of CAD, HF, ischemic stroke, peripheral arterial disease or chronic kidney failure before the 18-month index; cancer diagnosis within 6.5 years before index; and emigration before index.
To determine adherence levels, Morten Malmborg, MD, of the Danish Heart Foundation in Copenhagen, Denmark, and colleagues calculated the proportion of days covered (PDC) by statins within 1 year before index by analyzing consecutive claimed prescriptions. Incidence of first MI, first ischemic stroke or death was used to determine statin effectiveness. Follow-up was conducted until one of these events occurred, emigration or 5 years had elapsed after index.
Among the cohort, 56% were treated with statins, and among those taking statins, 72% had a PDC of at least 80%, the researchers wrote.
According to the researchers, high statin adherence was important for maintaining lower risk for CVD or death and was most effective in older patients.
For example, in men aged 70 to 79 years, the standardized 5-year CVD risk was 22.9% in those who took statins and 29.1% in those who did not (risk reduction, 6.2 percentage points; 95% CI, 4-8.4; P < .0001). In another example, women aged 80 to 89 years had a 5-year CVD risk reduction of 10.8% (95% CI, 7.2-14.4) if they took statins, whereas women aged 40 to 49 years had no risk reduction if they took statins (0%; 95% CI, –1 to 1).
There was no significant difference in adherence level or standardized risk difference between men and women, although standardized risks were higher for men. Men in all age groups and women older than 50 years treated with statins had a lower standardized 5-year risk for CVD and death than those who were not.
Among patients using statins, those with PDC less than 80% had higher standardized 5-year risk for CVD and death compared with those with PDC of at least 80%, Malmborg and colleagues wrote.
“We observed that women were more frequently treated with statins, and that a high proportion of patients (44%) were not treated with statins 6 months following type 2 diabetes diagnosis,” Malmborg and colleagues wrote.
Limitations included using observational data, precluding the ability to determine causal relations; approximated indication for statins and dose and treatment periods; and lack of diversity in Denmark. “Healthy adherer” effect may have played a role in the results but is less evident when stratifying for age, the researchers wrote.
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