Abstract
BackgroundThe benefit of statins for prevention of cardiovascular events in type 2 diabetes is established, but a gap exists between guideline recommendations and clinical practice. The aim of the study was to identify patient-related factors predicting statin prescription.MethodsWe assessed the quality of care in 51,640 patients with type 2 diabetes in a German diabetes registry. Patients were stratified according to primary and secondary prevention. Five-year risk for cardiovascular events was calculated in primary prevention patients. A multivariate adjusted logistic regression model was constructed to determine which parameters influenced statin prescription.Results34% had established atherosclerotic disease and 25.5% received a statin. Prescription was significantly higher in the secondary compared to the primary prevention group (38.1% [95% CI 37.4–38.9%] vs. 18.5% [95% CI 18.0–19.0%], respectively). In primary prevention the odds for statin prescription increased with estimated cardiovascular risk (OR 1.17 per 5% increase in 5-year risk, 95% CI 1.11–1.22). Positive predictors for statin prescription were secondary prevention, hypertension, former smoking, baseline LDL-cholesterol, and microalbuminuria. The odds of receiving a statin had an inverted U-shaped relation with age (nadir, 66 years), age at first diagnosis of diabetes (nadir, 56 years), and body mass index (nadir, 32 kg/m2). The model predicted prescription in 70% of the patients correctly.ConclusionThe majority of patients with type 2 diabetes are not receiving statins. The predominant factors determining statin prescription are the patient's prevention status and, in primary prevention, estimated cardiovascular risk. The results suggest that although physicians are aware of the general concept of cardiovascular risk, they fail to consistently implement guidelines.
Highlights
The benefit of statins for prevention of cardiovascular events in type 2 diabetes is established, but a gap exists between guideline recommendations and clinical practice
A recent meta-analysis examined whether statins (HMG-CoA reductase inhibitors) are as beneficial in preventing cardiovascular events in patients with diabetes as they are in those without, and found that in patients with diabetes there was a 9% proportional reduction in all-cause mortality per mmol/l (~40 mg/dl) reduction on low density lipoprotein (LDL) cholesterol, a reduction similar to the 13% reduction seen in patients without the disease [2]
We investigated in bivariate analyses factors associated with statin prescription in subjects stratified according to whether they had a history of coronary heart disease (CHD), stroke, or peripheral arterial occlusive disease, and in subjects presumed free of atherosclerotic complications
Summary
The benefit of statins for prevention of cardiovascular events in type 2 diabetes is established, but a gap exists between guideline recommendations and clinical practice. A recent meta-analysis examined whether statins (HMG-CoA reductase inhibitors) are as beneficial in preventing cardiovascular events in patients with diabetes as they are in those without, and found that in patients with diabetes there was a 9% proportional reduction in all-cause mortality per mmol/l (~40 mg/dl) reduction on LDL cholesterol, a reduction similar to the 13% reduction seen in patients without the disease [2]. Current type 2 diabetes guidelines issued by European and American scientific societies recommend lipid-lowering treatment with statins in order to reach the LDL-C target levels of < 100 mg/dl or of < 70 mg/dl in individuals with coexisting cardiovascular disease (CVD) [3,4,5]. Reports from other European countries [8,9] and the United States [10] show that not all eligible patients receive cholesterol-lowering therapy
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