Houston—About 40% of patients with diabetes aren’t prescribed a statin, even though the therapy could lower their risk of future heart attack, stroke, and related death.
That’s according to a research letter published in the Journal of the American College of Cardiology. It also reports wide variation in statin use across cardiology practices included in the study.
“Patients with diabetes, including those without established cardiovascular disease, have a very high risk of having a heart attack or stroke, and they are also more likely to die of one compared to people without diabetes,” explained senior author Salim Virani, MD, PhD, cardiologist at the Michael E. DeBakey Veterans Affairs Medical Center and associate professor at Baylor College of Medicine in Houston. “In this study, we found 38% of patients with diabetes were not on a statin, which can be lifesaving.”
A 57% practice-level variation in statin use persisted, even when patient factors such as age, gender, race, high blood pressure, high cholesterol, tobacco use, and insurance coverage were taken into account.
By comparison, an earlier analysis of statin use among similar patients within the VA healthcare system showed only 20% facility-level variation, which Virani said is likely a reflection of more consistent care, uniform protocols and information technologies, and more consistent medication formulary choices compared to individual cardiology practices.
“Such wide variation illustrates the gap between guideline recommendations and real world practice. Healthcare providers manage similar diabetes patients differently,” he noted. “While some variation is OK, what we found is concerning and may ultimately affect clinical outcomes.”
Unless contraindicated, statin therapy should be started and maintained in 40- to 75-year-old patients with diabetes whose LDL cholesterol level is more than 70 mg/dL, based on an assessment of risk, to prevent the development of cardiovascular disease, according to American College of Cardiology (ACC) and the American Heart Association guidelines in place since 2013. The American Diabetes Association also recommends that a statin be used to supplement lifestyle changes in patients with diabetes who are age 40 and older, regardless of baseline LDL cholesterol levels or whether they have cardiovascular disease.
For the study, researchers examined practice-level variations in statin therapy among 40- to 75-year-old patients with diabetes and no overt cardiovascular disease between May 2008 and October 2013, prior to release of the current guidelines. Data on 215,193 patients representing 582,048 encounters was obtained from the ACC’s PINNACLE registry, a national cardiology outpatient quality improvement registry that extracts data directly from electronic medical records.
Patients need to be educated on the need to lower their risks for heart attack, stroke, or related issues, according to the study authors.
“When these types of discussions happen, patients are more likely to receive evidence-based therapies including statins,” Virani emphasized. “Once one is prescribed, it’s important that patients take them and report any problems to their healthcare provider.”
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