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Statin use slowly increasing among patients with diabetes
The use of statin therapy among veterans with diabetes climbed steadily from 43% to 59% between 2003 and 2011, with patients who use oral antidiabetes agents combined with insulin and those with comorbid cardiovascular disease accounting for most new users, according to an analysis of patient data.
“Despite a consistent core of recommendations since 2002, less than 60% of the current population of patients with diabetes is taking a statin,” Meghan B. Brennan, MD, assistant professor at the University of Wisconsin School of Medicine and Public Health, and colleagues wrote. “While these cross-sectional estimates are informative, the adoption of statins has likely been dynamic, changing over time and in different subgroups. Understanding the real-world trends in statin use in a national cohort may help inform initiatives to optimize statin use for patients with diabetes and increase compliance with guideline recommendations.”
In a retrospective study, Brennan and colleagues analyzed data from all patients with diabetes aged at least 40 years who were treated in the VA health care system during 2003 (n = 899,664; 98% men; 77% white; 57% aged at least 65 years). Researchers followed patients from 2003 until death or Dec. 31, 2011. Primary outcome was the prevalence of statin use over time, with statin used defined as receipt of at least a 30-day supply during a 90-day period. In secondary analyses, researchers also examined statin use among patients not receiving cholesterol-lowering medications during the baseline period (2003 to March 30, 2003) and patients with comorbid CVD.
Within the cohort, 53.4% did not receive any cholesterol-lowering medications during the baseline period, 57.4% did not receive a statin and 54.9% had comorbid CVD at baseline. Average follow-up was 82 months.
During 9 years of follow-up, statin use increased from 42.6% at baseline to 59.2%, with patients 1.8% more likely to use statins in each succeeding 90-day period (P for trend < .001). In sensitivity analysis among those who survived the entire study period, results were similar, with statin use increasing from 44% to 60%. Among those with baseline CVD, statin use increased from 43% to 58%, according to researchers. The shift was slower among patients not taking a cholesterol-lowering medication at baseline, rising from 15% after the first year to 46% at 9 years.
Statin use differed by race. Hispanic patients saw the greatest increase in statin use, from 36% to 61%, whereas baseline statin use for black patients was 32%, rising to a high of 54% at 9 years.
Researchers observed that patients with diabetes who needed hypoglycemic agents, progressed to insulin therapy or had elevated HbA1c levels were more likely to fill a prescription for a statin. Compared with patients not taking hypoglycemic medications, patients taking both oral agents and insulin had a 19-fold increase in the likelihood of starting a statin (P < .001). Patients with HbA1c between 7% and 8.9% were 10% more likely to start a statin vs. those with HbA1c 7% or lower (adjusted OR = 1.1; 95% CI, 1.09-1.1). Odds of starting a statin also increased for patients with comorbid hypertension (OR = 2.78; 95% CI, 2.73-2.79), chronic heart failure (OR = 1.09; 95% CI, 1.08-1.1) or peripheral vascular disorders (OR = 1.18; 95% CI, 1.17-1.19).
“To best focus future interventions that improve compliance with ADA guidelines on statin use, we pose the following question: Should we target the relatively low-risk group of patients with diabetes, where the number of patients not on a statin is the greatest, but the individual risk reduction may be the least?” the researchers wrote. “Alternatively, should we aim to increase statin use among the higher-risk group of patients, where the number of patients who could benefit may be smaller, but the individual risk reduction would be greater?” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.