Statin Utilization Patterns among Type 2 Diabetes Mellitus Patients with High Cardiovascular Disease Risks in Ethiopia

Statin Utilization Patterns among Type 2 Diabetes Mellitus Patients with High Cardiovascular Disease Risks in Ethiopia

  • Tsegaye Melaku Jimma University
  • Yordanos Solomon Jimma University
  • Legese Chelkeba Jimma University
Keywords: Diabetes, Statin, Type 2 diabetes, cardiovascular disorders


Background: Use of statin therapy in patients with type 2 diabetes mellitus has been recommended by most clinical guidelines. Cardiovascular disease is a leading cause of morbidity and mortality among type 2 diabetes mellitus patients. It has been proved that statins are effective for primary or secondary cardiovascular disease prophylaxis. Objective: The main objective of the study was to assess pattern of statin use among type 2 diabetes mellitus patients with high risk of cardiovascular diseases at Jimma University Medical Center. Methods: Hospital based cross sectional study was conducted among type 2 diabetes mellitus ambulatory patients based on the inclusion criteria. Patient specific data was collected using structured data collection tool. Data was analyzed using statistical software package, SPSS version 20.0. To identify the independent predictors of statin use, multiple stepwise backward logistic regression analysis was done. Statistical significance was considered at p-value <0.05. Patient’s written informed consent was obtained after explaining the purpose of the study. Patients were informed about confidentiality of the information obtained. Results: From 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, with mean ± SD   of 46.65±19.61 years.  About 55(36.67%) of participants were on statin therapy for treatment and prophylaxis (primary& secondary prophylaxis).  Uncontrolled blood sugar (COR=1.643; 95% CI: 1.291–2.077; P=0.056), smoking (COR=1.102; 95% CI: 0.913–1.321; P=0.026) & long time with diabetes (COR=1.067; 95% CI: 1.007-14.659; P=0.021) showed statistically significant association with statin use.  Age between 65 to 74 years (AOR = 3.006; 95% CI: 1.440–6.277; P = 0.003), presence of co morbidity (AOR 4.486; 95% CI: 2.080–9.673; P<0.001) and elevated blood cholesterol (AOR = 1. 422; 95% CI: 1.244–1.622; P = 0.033), living with DM for more than 10 years (AOR=2.45; 95% CI: 1.524- 3.891; p=0.027) and uncontrolled blood sugar (AOR=2.127; 95% CI: 1.833–2.457; p=0.0241) were independent predictor of statin use. Conclusion: Despite contemporary recommendations that all people with diabetes should be treated with statins, majority of our patients with T2DM were not receiving statins. Further interventions to improve statin use should be considered for these high risk patients.


1. Ahern JA, Ramchandani N, Cooper J, Himmel A, Silver D, Tamborlane WV. Using a primary nurse manager to implement DCCT recommendations in a large pediatric program. The Diabetes Educator. 2000;26(6):990-4.
2. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. New England Journal of Medicine. 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. Annals of epidemiology. 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 England journal of medicine. 1998;339(4):229-34.
5. Miettinen H, Lehto S, Salomaa V, Mähönen M, Niemelä M, Haffner SM, 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. BMJ: British Medical Journal. 1998;317(7160):703.
7. Cheung BM. Statins for people with diabetes. The 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. Journal of the American Heart Association. 2016;5(2):e003144.
9. Dhippayom T, Fuangchan A, Tunpichart S, Chaiyakunapruk N. Opportunistic screening and health promotion for type 2 diabetes: an expanding public health role for the community pharmacist. Journal of Public Health. 2012;35(2):262-9.
10. Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD-summary. Diabetes & vascular disease research. 2014;11(3):133-73.
11. Stone NJ, Robinson JG, Lichtenstein AH, Merz CNB, Blum CB, Eckel RH, 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. Journal of the American College of Cardiology. 2014;63(25 Part B):2889-934.
12. 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.
13. 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 cardiovascular risk. Journal of managed care & specialty pharmacy. 2016;22(6):685-98.
14. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. The Annals of Family Medicine. 2009;7(4):357-63.
15. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, 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.
16. 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 Medicine. 2014;31(9):1055-63.
17. Jones N, Fischbacher C, Guthrie B, Leese G, Lindsay R, McKnight J, 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 Medicine. 2014;31(6):640-6.
18. 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. 2009;4(S 01):FV_72.
19. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, 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.
20. Pencina MJ, Navar-Boggan AM, D'Agostino Sr RB, Williams K, Neely B, Sniderman AD, et al. Application of new cholesterol guidelines to a population-based sample. New England Journal of Medicine. 2014;370(15):1422-31.
21. Kavousi M, Leening MJ, Nanchen D, Greenland P, Graham IM, Steyerberg EW, 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.
22. Feely J, McGettigan P, Kelly A. Growth in use of statins after trials is not targeted to most appropriate patients. Clinical Pharmacology & Therapeutics. 2000;67(4):438-41.
23. Majeed A, Moser K, Maxwell R. Age, sex and practice variations in the use of statins in general practice in England and Wales. Journal of Public Health. 2000;22(3):275-9.
24. Teeling M, Bennett K, Feely J. The influence of guidelines on the use of statins: analysis of prescribing trends 1998–2002. British journal of clinical pharmacology. 2005;59(2):227-32.
25. Ko DT, Mamdani M, Alter DA. Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. Jama. 2004;291(15):1864-70.
26. Agalliu I, Salinas CA, Hansten PD, Ostrander EA, Stanford JL. Statin use and risk of prostate cancer: results from a population-based epidemiologic study. American journal of epidemiology. 2008;168(3):250-60.
27. Neutel CI, Morrison H, Campbell NR, de Groh M. Statin use in Canadians: trends, determinants and persistence. Canadian Journal of Public Health/Revue Canadienne de Sante'e Publique. 2007:412-6.
28. 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.
29. Association AD. Standards of medical care in diabetes—2013. Diabetes care. 2013;36(Suppl 1):S11.
30. 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. The Journal of clinical investigation. 1995;95(1):158-66.
How to Cite
Melaku T, Solomon Y, Chelkeba L. Statin Utilization Patterns among Type 2 Diabetes Mellitus Patients with High Cardiovascular Disease Risks in Ethiopia. J Pharm Care. 6(3-4):44-51.
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