Prescription Of Statins In Patients Research Articles

Adherence to Statin Among Diabetic Patients in Diabetic Centers in Qassim Region, Saudi Arabia.

Background Dyslipidemia affects approximately one-third of Saudi Arabia's adult population. Dyslipidemia, hypertension, diabetes mellitus (DM), smoking, and a familial predisposition to cardiovascular disease (CVD) are significant risk factors for CVD. It can be prevented effectively through lifestyle changes and lifelong statin therapy; however, poor adherence limits its effectiveness. This study is designed to assess the level of adherence to statin prescription in patients with DM in diabetic centers in the Qassim region and to assess the factors associated with neglecting to take medication. Methodology A cross-sectional study was conducted among 226 diabetic patients who were prescribed statins. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Demographic and clinical data were collected, and multivariate logistic regression analysis was used to identify factors associated with medication adherence. Results Of the 226 patients, 29.7% had high adherence, 32.7% had medium adherence, and 37.6% had low adherence to statin medication. Patients diagnosed with diabetes for less than five years had the highest proportion of low adherence (41.2%). No significant associations were found between medication adherence and gender, nationality, or educational level. Conclusion The study found that medication adherence to statins in diabetic patients in the Al Qassim region of Saudi Arabia is suboptimal, with a significant proportion of patients having low adherence. Patients diagnosed with diabetes for less than five years had the highest proportion of low adherence, suggesting that patients with a shorter disease duration may require additional support or interventions to improve their medication adherence. Healthcare providers should emphasize the importance of medication adherence and work with patients to develop personalized treatment plans that include medication and lifestyle modifications to optimize lipid control and improve overall health outcomes in diabetic patients.

Disparities in statin prescription among patients with severe hypercholesterolemia in an integrated healthcare system

BackgroundSevere hypercholesterolemia (SH), defined as a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dl, is associated with an increased risk for premature atherosclerotic cardiovascular disease. Despite guideline recommendations, many patients with severe hypercholesterolemia remain untreated. We conducted an observational analysis of a large pool of SH patients, exploring demographic and social factors contributing to disparities in the prescription of statin and other lipid-lowering therapies. MethodsWe included all adults (age 18 or older) in the University Hospitals Health Care System, with an LDL-C ≥ 190 mg/dl on a lipid profile drawn between January 2, 2014, and March 15, 2022. Variables were compared across relevant categories of age, gender, race and ethnicity, medical history, prescription medication status, insurance type, and provider referral type. We used the Fischer exact test and Pearson Chi-square (χ 2) for variable comparisons. ResultsA total of 7,942 patients were included in the study. The median age was 57 [IQR 48–66] years with 64% female, and 17% Black patients. Only 58% of the total cohort was prescribed statin therapy. Higher age was independently associated with a higher likelihood of receiving a statin, with an odds ratio of 1.25 (95% CI [1.21 – 1.30] per 10 years, p<0.001). Additional factors that were associated with higher rates of statin prescription in patients with SH were Black race (OR 1.90, 95% CI [1.65 – 2.17], p<0.001), smoking (OR 2.42, 95% CI [2.17 -2.70], p<0.001), and presence of diabetes (OR 3.88, 95% CI [3.27 – 4.60], p<0.001). Similar trends were also seen with other lipid-lowering therapies such as ezetimibe and fibrates. ConclusionsIn our Northeast Ohio healthcare system, less than two-thirds of patients with severe hypercholesterolemia are prescribed a statin. Statin prescription rates were highly dependent on age and the presence of additional ASCVD risk factors.

Adherence to Clinical Guidelines on STATIN Prescribing Among Diabetic Patients Aged 40-75 Years Old in a Primary Care Setting: A Cross-Sectional Study.

BackgroundDiabetes mellitus (D.M.) is a chronic metabolic disease caused by decreased insulin secretion, which increases the risk of cardiovascular diseases. Evidence has shown that statins reduce cardiovascular risk in patients with diabetes; moreover, most clinical guidelines recommend statins.ObjectiveThis study aimed to assess the level and status of adherence to guidelines on statin prescription in patients with diabetes mellitus in a primary care setting in Palestine.MethodsA retrospective cross-sectional descriptive study was conducted at an ambulatory center in Palestine. Data were collected by auditing prescription records and reviewing medical charts of patients with diabetes who visited the clinic from February 15 to March 17, 2021. The collected data included patient characteristics, comorbidities, lipid profiles, and statin prescription. A chi-square test was used to evaluate the appropriateness of the prescribed statins with different demographic and clinical variables. Statistical significance was set at p < 0.05. Statistical Package for Social Sciences (SPSS) version 22 was used to analyze the data.ResultsOut Of 262 diabetic patients included in the analysis, 74% were prescribed appropriate statin therapy according to the American Diabetes Association (ADA) guidelines, and 24% of patients had inappropriate statin therapy or needed statins. Furthermore, 82.8% were on high-intensity statins, while 11% were not taking any statins. More than 60% of patients had uncontrolled diabetes and hypertension.ConclusionMost guidelines recommend statin therapy in diabetic patients owing to its benefits in preventing cardiovascular complications. In this study, most patients were on appropriate STATIN therapy; however, 50% of diabetic patients had LDL of more than 100 mg/dl, and 25% were not prescribed statins, increasing their risk of ASCVD. Therefore, we recommend strict adherence to the established guidelines on statins prescribed to patients with diabetes to prevent cardiovascular complications, save lives, and reduce healthcare costs.

How strong is the evidence to support statins repurposing for the treatment of cirrhosis?

In this editorial, we briefly mention the studies that support the use of statins to change the natural history of liver cirrhosis, alongside potential biases and flaws that need to be considered when analyzing data. The key message that we want to communicate is that even if current evidence is somehow compelling, it is limited, mostly from observational studies, and in general not enough to formally recommend the prescription of statins in patients with cirrhosis as disease-modifying agents. Finally, we also mention some important facts about the safety of statins in the context of patients with underlying liver disease.

Statin prescription in patients with chronic obstructive pulmonary disease and risk of exacerbations: a retrospective cohort study in the Clinical Practice Research Datalink

ObjectiveObservational studies have suggested a beneficial effect of taking statins on frequency of chronic obstructive pulmonary disease (COPD) exacerbations. However, clinical trials of statins in people with COPD did not...

Cardiovascular Disease Risk-Based Statin Utilization and Associated Outcomes in a Primary Prevention Cohort: Insights From a Large Health Care Network.

Current American College of Cardiology/American Heart Association guidelines recommend using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk to guide statin therapy for primary prevention. Real-world data on adherence and consequences of nonadherence to the guidelines in primary are limited. We investigated the guideline-directed statin intensity (GDSI) and associated outcomes in a large health care system, stratified by ASCVD risk. Statin prescription in patients without coronary artery disease, peripheral vascular disease, or ischemic stroke were evaluated within a large health care network (2013-2017) using electronic medical health records. Patient categories constructed by the 10-year ASCVD risk were borderline (5%-7.4%), intermediate (7.5%-19.9%), or high (≥20%). The GDSI (before time of first event) was defined as none or any intensity for borderline, and at least moderate for intermediate and high-risk groups. Mean (±SD) time to start/change to GDSI from first interaction in health care and incident rates (per 1000 person-years) for each outcome were calculated. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization. Among 282 298 patients (mean age ≈50 years), 29 134 (10.3%), 63 299 (22.4%), and 26 687 (9.5%) were categorized as borderline, intermediate, and high risk, respectively. Among intermediate and high-risk categories, 27 358 (43%) and 8300 (31%) patients did not receive any statin, respectively. Only 17 519 (65.6%) high-risk patients who were prescribed a statin received GDSI. The mean time to GDSI was ≈2 years among the intermediate and high-risk groups. At a median follow-up of 6 years, there was a graded increase in risk of ASCVD events in intermediate risk (hazard ratio=1.15 [1.07-1.24]) and high risk (hazard ratio=1.27 [1.17-1.37]) when comparing no statin use with GDSI therapy. Similarly, mortality risk among intermediate and high-risk groups was higher in no statin use versus GDSI. In a real-world primary prevention cohort, over one-third of statin-eligible patients were not prescribed statin therapy. Among those receiving a statin, mean time to GDSI was ≈2 years. The consequences of nonadherence to guidelines are illustrated by greater incident ASCVD and mortality events. Further research can develop and optimize health care system strategies for primary prevention.

Effect Of The Covid-19 Pandemic On Coronary Artery Calcium Testing And Subsequent Statin Prescription

Introduction: The 2018 ACC/AHA Cholesterol Guideline advocates for the use of coronary artery calcium (CAC) screening in intermediate risk patients in whom the decision about statin therapy is uncertain, and suggests that statin therapy is generally indicated for all patients with CAC score >100. We sought to assess temporal trends with the impact of the COVID-19 pandemic on the use of CAC testing and downstream statin prescription in patients with a CAC >100.

Abstract 16657: Guideline Recommended Statin Therapy and Sex Based Cardiovascular Disease Outcomes: Data From a Multi-site Healthcare Network Primary Prevention Cohort

Introduction: Statin therapy has been shown to reduce ASCVD morbidity and mortality. Evidence on statin utilization per the ACC/AHA cholesterol guidelines and outcomes are limited in primary prevention cohorts of women. We investigated statin use outcomes per 10-year ASCVD risk in a large healthcare system stratified by sex. Methods: Statin prescription in patients without CAD (MI or revascularization) or ischemic stroke were evaluated (2013-2019). Risk categories per the ASCVD risk were defined as: Borderline (5%-7.4%), Intermediate (7.5%-19.9%) or High (≥20%). Guideline-directed statin intensity (GDSI), at time of first event, was defined as: “at least moderate” for Intermediate and high -risk groups. Cox regression hazard ratios (HR) [95% CI] were calculated for statin use and outcomes (MI, stroke and composite ASCVD events) stratified by gender. Interaction terms (age ≥75y and sex) were applied. Results: Among 159,100 women (out of 282,298 patients; mean age ~51y), 15,153 (9.5%), 26,697 (16.8%) and 10,583 (6.7%) were categorized as borderline, intermediate and high risk, respectively. Only 9,277 (35%) intermediate and 4,893 (46%) of high-risk women received any intensity of statin. High risk women (vs men) on GDSI, had lower association with CAD events (HR 0.8 [0.7-0.9]) and increased stroke risk (HR 1.2 [1.1-1.4]) ( Table). Intermediate and high-risk women (on &lt;GD statin or no statin) had higher stroke risk than those on GD statin (p for interaction &lt;0.001 ). Older women (≥75y) on “no statin” (vs GD statin) had independently increased risk of CAD (HR 1.30[1.1-1.6]) (p interaction &lt;0.001) . Conclusions: In a real-world primary prevention cohort, women on statin therapy had significantly improved ASCVD outcomes and lower mortality. However, approximately one-fourth of statin-eligible women were not prescribed any statin therapy. Further research can develop healthcare system strategies to optimize under-treatment of women for ASCVD prevention.

P822Statin treatment in symptomatic patients with non-obstructive coronary artery disease reduces the risk of all-cause mortality

Abstract Introduction Symptomatic patients with non-obstructive coronary artery disease (NOCAD; stenosis &gt;0% &lt;50%) have a worse prognosis and an increased risk for all-cause mortality compared with age-matched controls. Currently, treatment of these patients is empiric, and secondary preventive measures are less often implemented. The goal of the study was to examine whether statin prescription has an impact on all-cause mortality in symptomatic NOCAD patients, and which factors influence statin prescription in patients with NOCAD. Methods We examined 4039 symptomatic patients who presented either with stable angina (SA) or an acute coronary syndrome (ACS) who underwent coronary angiography; 1582 had angiographically normal coronary arteries, 2457 had minimal disease (NOCAD). The comparison group consisted of 2998 patients with stable obstructive CAD (stenosis ≥50%). Patients had at least one lipid panel tested between April 1, 2010 to March 31, 2014. We examined the rate of statin prescription amongst the groups, as well as predictors of all-cause mortality and statin treatment. Results Symptomatic patients with NOCAD are less likely to receive statin therapy (60.4%) compared to patients with obstructive CAD (87.3%). After one, three and five year(s), LDL levels in NOCAD patients are higher than in CAD patients (2.21±0.88mmol/l vs. 1.84mmol/l±0.77mmol/l after 1 year). Statin treatment was associated with a significantly lower risk of all-cause mortality in NOCAD (HR 0.64 (0.44–0.95)), as well as in CAD (HR 0.44 (0.31–0.62)), but not in patients with normal coronaries HR 0.55 (0.27–1.15)). Sex, age and the presence of other cardiovascular risk factors influenced the prescription of statin therapy in the first 5 years after initial diagnosis of NOCAD- older patients with diabetes and hypertension were more likely to receive statin therapy. Women received statin therapy to a lower percentage than men in the NOCAD group (year 1: men 62.9% vs, women 56.9%; p=0.003). No effect of cardiovascular risk factors, age or sex on statin prescription was seen in the CAD group or patients with normal coronaries. Conclusion Statin therapy reduces the risk of all-cause mortality in symptomatic patients with NOCAD. In spite of this benefit, patients with NOCAD, and especially women, are less likely to receive secondary-preventive statin therapy.

Ambivalence about the selection of cardiovascular risk stratification tools: Evidence in a type 1 diabetes population

BackgroundCardiovascular disease (CVD) is one of the leading causes of death among people with diabetes, however, despite the increasing incidence of CVD, there are few tools for evaluating Cardiovascular Risk (CVR) in the population of patients with Type 1 Diabetes (T1D), with the existing ones diverging in the stratification of risk and in the suggestions for therapeutic conduct. MethodsA cross-sectional study was carried out with 104 participants diagnosed with T1D, aged 18–40, attending specialized services. The Steno Type 1 Risk Engine and the Cardiovascular Risk Stratification Calculator (CRSC) were used to assess the risk of a cardiovascular event over a 10-year period. FindingsOf the total sample selected, 62% were female, with a median age of 32 years (IQ 24; 43). There was a large difference between the stratification of CVR between the calculators, and 65.82% of the patients classified as low risk for CVD according to the Steno were identified as intermediate (30, 38.00%) and high risk (35.44%) by the CRSC. The analysis also highlighted a great difference in eligibility for statin use according to the risk stratification of the tools. ConclusionThe CRSC and Steno tools evaluated and stratified the CVR of the same population with T1D, with there being divergence of the results. It was found that the CRSC tool classified the majority of the sample as high risk. Due to this result, the eligibility to use statins, which is one of the applications of these tools, showed great differences, with the Steno tool presenting less aggressive provisions regarding the prescription of statins in patients with type 1 DM.

Deprescribing: a challenge for clinical cardiologists

Deprescribing is a holistic process to identify medications that can be ceased, substituted or reduced. This process can improve the health of older patients and also enhance their compliance to the prescribed medications which are actually beneficial. Recommendations and guidelines have been elaborated for extensively prescribed drugs. In clinical cardiology the process of deprescribing is a challenge for doctors because of withdrawal-related adverse effects, but it may be applied in certain clinical conditions such as the discontinuation of statin prescription in patients with advanced senile dementia and those with limited life expectancy. Deprescribing is also focussed on the scarcely known effects of prolonged therapy after the acute phase of a disease is over, especially when continuation may signify potential life-long treatment. There needs to be collaboration between the consultant cardiologist who first prescribes medications and family doctors who are responsible for the long-term care of the patient and reviewing prescribed medications may be necessary.

Statin Prescription for Patients With Atherosclerotic Cardiovascular Disease from National Survey Data

Despite strong evidence for the use of statins for patients with atherosclerotic cardiovascular disease (ASCVD), statin prescription is still suboptimal. We aimed to determine the rates and factors that influence statin prescription using national survey data. This is a cross-sectional retrospective study on 8,468 patients with clinical ASCVD who were drawn from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from years 2011 to 2015. Survey-weighted analysis was conducted to estimate weighted prevalence and odds ratios for statin prescription. There was a significant increase in statin prescription from the years 2011 to 2015. Nevertheless, only 52% of ASCVD patients (55.4% in coronary heart disease and 37.7% in noncoronary heart disease) were prescribed a statin. Based on multivariable regression analysis, after adjusting for covariates, males had 1.28 (1.06, 1.55) higher odds of statin prescription, in coronary heart disease patients only. In the overall study population, Black n on-Hispanics had 31% lower odds of statin prescription compared with White non-Hispanics, and patients seen only by a healthcare provider other than a physician were 80% less likely to have a statin prescribed to them. In conclusion, the disparity in statin prescription in patients with ASCVD exists across minority groups, and our findings underscore existing variations in healthcare delivery.

Rate of Statin Prescription in Younger Patients With Severe Dyslipidemia

Cardiovascular disease affects 1 in 3 patients and remains the leading cause of death in the United States.1 Severe elevation of low-density lipoprotein cholesterol (LDL-C) levels is a modifiable risk factor for developing premature cardiovascular disease, and elevation levels of 190 mg/dL or greater (to convert LDL-C values to millimoles per liter, multiply by 0.0259) may indicate a monogenic etiology such as familial hypercholesterolemia.2 Treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or statins is recommended (class IA) for all adults 21 years or older with an LDL-C of 190 mg/dL or greater. Statin treatment appears to reduce mortality and result in cost savings for health systems.3,4 Therefore, we sought to examine rates of statin prescription in patients screened for dyslipidemia to identify treatment gaps in a real-world contemporary setting.

HYPOLIPIDEMIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE IN 2004-2010 ACCORDING TO THE PROGNOZ IBS REGISTER

Aim. To evaluate the frequency of prescription, efficacy and patients adherence to statin therapy in a cohort of patients with ischemic heart disease (IHD), confirmed by coronary angiography data, during the period from 2004 to 2010 based on the data from the PROGNOZ IBS register. Material and methods. The PROGNOZ IBS register database was used in the study. The data of 550 patients from a cohort of patients with the confirmed IHD, who had undergone coronary angiography from 2004 to 2008 (303 of them were on the follow-up visit) were included in the final analysis. Results. Low frequency of statins prescription in patients with stable IHD prior to hospitalization in 2004-2007 and a significant improvement of its quality during the stay in a specialized cardiology unit were revealed in the PROGNOZ IBS register. The frequency of statin prescription at discharge increased from 10% to 85.5% (in most cases original drugs were used), but the prescribed doses were usually inadequate. Target blood lipid levels were not achieved in the majority of patients. The level of low density cholesterol <2.5 mmol/L at discharge was present in 6.3% of the patients (the short period of hospitalization insufficient for the achievement of statins maximum effect should be taken into consideration). 67% of patients had good adherence to lipid-lowering therapy 3.9 years after the admission, however, the original drugs had been replaced by a variety of generics in most patients. The efficacy of the therapy was inadequate: the target levels of total cholesterol (<4.5 mmol/L) and low density cholesterol (<2.5 mmol/L) were achieved in 40% of patients, of low density cholesterol (<2.0 mmol/l) - in 15.8%. Conclusion. Low frequency of statins prescription in patients with stable IHD before the admission to the hospital, its significant growth during the stay and its reduction after the discharge were revealed. The treatment efficacy was low at all stages of the observation. Patients' adherence to statin therapy in the outpatient setting remains inadequate.

Statins for Patients with Cardiogenic Shock

of a large and complete dataset following patients with acute myocardial infarction for more than 2 years. They concluded from propensity score analyses that statins were associated with decreased in-hospital mortality and 12-month adverse cardiac events. Their conclusions are debatable. First, the inclusion criterion–Killip 4, a proxy for cardiogenic shock (CS)–is an issue. The population does not reflect real CS as severity indicators (acute kidney injury, <5%; mechanical ventilation, 38%) and mortality (–23%) are low. Furthermore, major prognostic markers such as extra-renal replacement, serum lactates and catecholamine use are lacking. Thus, the study evaluates the prognosis impact of statin prescription in “serious” ST segment elevation myocardial infarction (STEMI) (intraaortic balloon pump, 28%; cardiac arrest, 18%) with a poor definition of CS. 2) The Kaplan Meyer curve shows that most deaths occur early during the hospital stay, and this is an obvious survival bias. Patients with severe presentation and rapid death may not have received statins. In a large registry spanning over three decades, patients with STEMI with CS were less likely to receive optimal medical treatment with betablockers, aspirin and lipid lowering agents than those without CS (20% vs. 31%, p<0.001). 3) In order to deal with survivor bias, we examined statin prescription in patients with ischemic CS surviving the initial phase of CS. In our retrospective study of 249 patients with CS of varying etiology, hospital mortality was high, Letter to the Editor

Effectiveness of a national cardiovascular disease risk assessment program (NHS Health Check): Results after one year

ObjectiveWe aimed to assess whether the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program, was associated with reduction in CVD risk in attendees after one year. MethodsWe extracted data from patients aged 40–74years, with high estimated CVD risk, who were registered with general practices in a deprived, culturally diverse setting in England. We included 4748 patients at baseline (July 2008–November 2009), with 3712 at follow-up (December 2009–March 2011). We used a pre–post study design to assess changes in global CVD risk, individual CVD risk factors and statin prescription in patients with a complete and partial Health Check. ResultsThere were significant reductions in mean CVD risk score (28.2%; 95% confidence interval (CI)=27.3–29.1 to 26.2%; 95% CI, 25.4–27.1), diastolic blood pressure, total cholesterol levels and lipid ratios after one year in patients with a complete Health Check. Statin prescription increased from 14.0% (95% CI=11.9–16.0) to 60.6% (95% CI=57.7–63.5). ConclusionsThe introduction of NHS Health Check was associated with significant but modest reductions in CVD risk among screened high-risk individuals. Further cost-effectiveness analysis and work accounting for uptake is required to assess whether the program can make significant changes to population health.

Analgesic Drug Use Associated with Statin Prescription – A Cross- Sectional Study in Primary Care Settings

To investigate whether features of muscular complaints (MC) differ between receivers of a statin prescription and non-receivers. To analyze the relationship between analgesics prescription, statin prescription and/or musculoskeletal disorders. Cross-sectional study. Consecutive patients in offices of family practitioners were interviewed using a standardized questionnaire. Target variables: Rates of features of MC in patients with or without a statin prescription and rates of analgesic drug prescription in patients with or without statin prescription and/or musculoskeletal disorders. Odds ratios (adjusted for age, sex, and socio-economic status) were calculated using logistic regression analysis. 1135 patients in 26 general practitioners' offices were asked to participate, and 1031 patients agreed. Features of MC did not differ between the two groups of patients. Analgesic prescription was found to be associated with statin prescription in patients without musculoskeletal disorders (OR 2.2, CI 1.1-4.7 without statin, OR 2.5, CI 0.9-6.9 with statin) and particularly in those with musculoskeletal disorders (OR 5.2, CI 2.9-9.3 without statin, OR 9.3, CI 4.5-19.1 with statin). Analgesic prescriptions are probably positively associated with statin prescription. Assuming that analgesics attenuate MC, an even stronger association between MC and statin use seems likely. The results generate the hypothesis that statin use contributes to analgesic use in primary care patients.

Statin medication in patients treated with antiepileptic drugs in Norway

The lipid-lowering response of statins metabolized by cytochrome P450 3A4 (CYP3A4) has previously been shown to be diminished by concurrent use of enzyme-inducing antiepileptic drugs (EIAEDs). The aim of this study was to compare statin prescription in patients receiving EIAEDs versus non-enzyme-inducing antiepileptic drugs (NEIAEDs), before and after introduction of prescribing restrictions for statins in Norway. The Norwegian Prescription Database was used to extract data on patients using antiepileptic drugs and statins during 2004 and 2008. Statin type and dose used were compared between patients treated with at least one EIAED (i.e., carbamazepine, phenobarbital, phenytoin, primidone) and those receiving NEIAEDs only (i.e., all other antiepileptic drugs). The number of included patients co-medicated with statins and AEDs was 4855 in 2004 and 9880 in 2008. Among these patients, 2827 and 3160, respectively, were treated with EIAEDs. The CYP3A4 statins (i.e., simvastatin, atorvastatin and lovastatin) accounted for 85% of all statins in 2004, increasing to 93% in 2008. There was no significant difference in the likelihood of being prescribed a CYP3A4 statin versus a non-CYP3A4 statin among patients receiving EIAEDs and NEIAEDs. The average daily dose of individual CYP3A4 statins was not different between the AED groups. The present study shows that the interaction risk between CYP3A4-metabolized statins and EIAEDs is largely overlooked in Norwegian clinical practice. To avoid therapeutic failure of statin treatment in patients using AEDs, implementation of strategies for systematic management of drug interactions is warranted.

Patterns and predictors of statin prescription in patients with type 2 diabetes in Germany: Data from the DUTY registry

Aim of the study: The benefit of statins for the prevention of cardiovascular events in patients with type 2 diabetes is well established, but a gap exists between treatment recommendations in guidelines and clinical practice. The aim of the study was to identify patient-related factors predicting the prescription (or not) of a statin in a large cross-sectional data base (DUTY registry).

Patterns and predictors of statin prescription in patients with type 2 diabetes

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.