Treatment gap in the use of lipid-lowering drug therapy in diabetes: a population-based study.

Abstract

Lowering cholesterol is highly effective in reducing morbidity and mortality in high-risk people with prevalent cardiovascular disease. To investigate lipid-lowering therapy use for secondary prevention of coronary heart disease in all diabetic patients in Tayside, Scotland. Among the 385,500 Tayside residents on 31 March 2001, the DARTS database identified all people with Types 1 and 2 diabetes with prevalent macrovascular disease, defined as a history of angina or coronary heart disease. The uptake of lipid-lowering drug was ascertained from MEMO's database of prescriptions dispensed at Tayside pharmacies. Among the 1128 Type 1 patients, 11.3% had prevalent macrovascular disease and 7.9% used lipid-lowering therapy with 42.2% for patients with macrovascular disease. Current/former smokers (OR 2.40, 95% CI: 1.15-5.03) and those with a history of coronary heart disease (OR 2.26, 95% CI: 1.04-4.90) were more likely to use lipid-lowering therapy. Among the 8686 Type 2 patients, 38.8% had prevalent macrovascular disease and 18.3% used lipid-lowering therapy, with 26.7% for patients with macrovascular disease. Current/former smokers (OR 1.37; 95% CI 1.17-1.61) and those with a history of coronary heart disease (OR 2.07, 95% CI 1.66-2.59) or angina (OR 1.30, CI 1.03-1.63) were more likely to use lipid-lowering therapy. A duration of 4 years or less from the first macrovascular event was associated with increased use (OR 1.27; 95% CI 1.05-1.54). Age > 70 years reduced the likelihood (OR 0.51, CI 0.44-0.60). A clear gap exists between those requiring lipid-lowering drug therapy and those who are actually receiving it in Tayside.