Statin Utilization Patterns among Type 2 Diabetes Mellitus Patients with High Cardiovascular Disease Risks in Ethiopia
Background: Cardiovascular disease is a leading cause of morbidity and mortality among type 2 diabetes mellitus (T2DM) patients. It has been proved & recommended by most guidelines that statins are effective for primary or secondary cardiovascular diseases prophylaxis. The aim of the study was to assess the pattern of statin use among T2DM patients with high risk of cardiovascular diseases.
Methods: Hospital-based cross-sectional study was conducted among T2DM patients from February to April 2018 at Jimma University Medical Center. Patient-specific data including clinical characteristics, laboratory work ups and medication records were collected using a structured data collection tool.
Results: Mrom a total of 150 study participants, 93(62%) of them were males. Majority of the patient, 112(74.7%), were between age of 40-64 years (mean ± SD of 46.65±19.61 years). About 55(36.67%) of participants were on statin therapy for treatment & prophylaxis. Age between 65 to 74 years (AOR = 3.006; 95% CI: 1.440–6.277; P=0.003), disease co-morbidity (AOR 4.486; 95% CI: 2.080–9.673; P<0.001) & elevated blood cholesterol (AOR = 1. 422; 95% CI: 1.244–1.622; P=0.033), living with diabetes mellitus for more than 10 years (AOR=2.45; 95% CI: 1.524- 3.891; P=0.027) & uncontrolled blood sugar (AOR=2.127; 95% CI: 1.833–2.457; P=0.0241) were independent predictor of statin use.
Conclusion: The majority of patients with type 2 diabetes were not receiving statins. Further interventions to improve statin use should be considered for these high-risk patients
2. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. New Engl J Med 2010;362(12):1090-101.
3. Feldman HA, Johannes CB, Mckinlay JB, Longcope C. Low dehydroepiandrosterone sulfate and heart disease in middle-aged men:cross-sectional results from the Massachusetts Male Aging Study. AnnEpidemiol 1998;8(4):217-28.
4. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. New Engl J Med 1998;339(4):229-34.
5. Miettinen H, Lehto S, Salomaa V, et al. Impact of diabetes on mortality after the first myocardial infarction. Diabetes Care 1998;21(1):69-75.
6. Group UPDS. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.BMJ1998;317(7160):703.
7. Cheung BM. Statins for people with diabetes. Lancet 2008;371(9607):94-5.
8. Hoffmann U, Massaro JM, D’Agostino Sr RB, Kathiresan S, Fox CS,O’Donnell CJ. Cardiovascular event prediction and risk reclassification by coronary, aortic, and valvular calcification in the Framingham Heart Study.J Am Heart Assoc 2016;5(2):e003144.
9. Association AD. 9. Cardiovascular disease and risk management: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S86-S104.
10. Chamberlain JJ, Johnson EL, Leal S, Rhinehart AS, Shubrook JH, Peterson L. Cardiovascular disease and risk management: review of the American Diabetes Association standards of medical care in diabetes 2018. Ann
Intern Med 2018;168(9):640-50.
11. Ryden L, Grant PJ, Anker SD, et al. ESC guidelines on diabetes, prediabetes, and cardiovascular diseases developed in collaboration with the EASD-summary. Diab Vasc Dis Res 2014;11(3):133-73.
12. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63(25 Part B):2889-934.
13. LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999;282(24):2340-6.
14. Lin I, Sung J, Sanchez RJ, Mallya UG, Friedman M, Panaccio M, et al. Patterns of statin use in a real-world population of patients at high card ovascular risk. J Manag Care Spec Pharm 2016;22(6):685-98.
15. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services.Ann Fam Med 2009;7(4):357-63.
16. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).JAMA 2014;311(5):507-20.
17. Jansson SP, Svärdsudd K, Andersson D. Effects of fasting blood glucose levels and blood pressure and treatment of diabetes and hypertension on the incidence of cardiovascular disease: a study of 740 patients with incident Type 2 diabetes with up to 30 years’ follow‐up. Diabetic Med 2014;31(9):1055-63.
18. Jones N, Fischbacher C, Guthrie B, et al. Factors associated with statin Treatment for the primary prevention of cardiovascular disease in people Within 2 years following diagnosis of diabetes in Scotland, 2006–2008.
Diabetic Med 2014;31(6):640-6.
19. Gouni-Berthold I, Krone W, Böhm M, Bestehorn K, Berthold H. Patterns and predictors of statin prescription in patients with type 2 diabetes in Germany: Data from the DUTY registry. Diabetologie und Stoffwechsel
20. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European
Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016 ;253:281-344.
21. Pencina MJ, Navar-Boggan AM, D’Agostino Sr RB, et al. Application of new cholesterol guidelines to a population-based sample. New Engl J Med 2014;370(15):1422-31.
22. Kavousi M, Leening MJ, Nanchen D, et al. Comparison of application of the ACC/AHA guidelines, Adult Treatment Panel III guidelines, and European Society of Cardiology guidelines for cardiovascular disease prevention in a
European cohort. JAMA 2014;311(14):1416-23.
23. Feely J, McGettigan P, Kelly A. Growth in use of statins after trials is not targeted to most appropriate patients. Clin Pharmacol Ther 2000;67(4):438-41.
24. Majeed A, Moser K, Maxwell R. Age, sex and practice variations in the use of statins in general practice in England and Wales. J Public Health 2000;22(3):275-9.
25. Teeling M, Bennett K, Feely J. The influence of guidelines on the use of statins: analysis of prescribing trends 1998–2002. Brit J Clin Pharmacol 2005;59(2):227-32.
26. Ko DT, Mamdani M, Alter DA. Lipid-lowering therapy with statins in highrisk elderly patients: the treatment-risk paradox. JAMA 2004;291(15):1864- 70.
27. Agalliu I, Salinas CA, Hansten PD, Ostrander EA, Stanford JL. Statin use and risk of prostate cancer: results from a population-based epidemiologic study. Am J Epidemiol 2008;168(3):250-60.
28. Neutel CI, Morrison H, Campbell NR, de Groh M. Statin use in Canadians: trends, determinants and persistence. Can J Public Health 2007;98(5):412-6.
29. Elnaem MH, Nik Mohamed MH, Huri HZ, Shah M, Shah A. Patterns of statin therapy prescribing among hospitalized patients with Type 2 diabetes mellitus in two Malaysian tertiary hospitals. Tropical Journal of Pharmaceutical Research 2017;16(12):3005-11
30. Association AD. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(Suppl 1):S11.
31. Lewis GF, Uffelman KD, Szeto LW, Weller B, Steiner G. Interaction between free fatty acids and insulin in the acute control of very low density lipoprotein production in humans. J Clin Invest 1995;95(1):158-66.