Statin Therapy Underused in Older Adults with Diabetes

About 40% of patients with diabetes who should be receiving statin therapy to reduce their risk of cardiovascular (CV) events are not receiving the therapy, according to a new analysis.1 Results also showed a wide variation in statin use.

Current guidelines published by the American College of Cardiology and the American Heart Association recommend starting and maintaining statin therapy in patients with diabetes aged 40 to 75 years whose cholesterol level is 70 mg/dL or higher to prevent CV disease.

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Patients with diabetes who receive statins after a CV event have a significantly lower risk of a subsequent event. However, this study is one of the first to examine real-world trends in statin use among patients with diabetes who have had a heart attack, stroke, or other CV event.

To better understand statin prescribing practices, the researchers assessed statin use variation among patients aged 40 to 75 years who had diabetes and no CV disease and were in the American College of Cardiology’s PINNACLE (Practice INNovation And CLinical Excellence) registry between May 2008 and October 2013.

The researchers tracked statin prescription during the study period by using the medical records in the PINNACLE registry.

Hierarchical-modified Poisson regression models were used to calculate cardiology practices’ median statin prescription rates, quarterly trends, and median rate ratio (MRR) for statin prescription and MRR for achieving a low-density lipoprotein cholesterol (LDL-C) level below 100 mg/dL.

Analysis showed a 57% practice-level variation in statin use among cardiology practices included in the study.

“Such wide variation illustrates the gap between guideline recommendations and real world practice. Health care providers manage similar diabetes patients differently,” the researchers concluded. “While some variation is OK, what we found is concerning and may ultimately affect clinical outcomes.”2

—Amanda Balbi

Reference:

  1. Pokharel Y, Gosch K, Nambi V, et al. Practice-level variation in statin use among patients with diabetes: insights from the PINNACLE registry. J Am Coll Cardiol. 2016;68(12):1368-1369. doi:10.1016/j.jacc.2016.06.048.
  2. Low statin use in people with diabetes despite cardioprotective effects, guidelines: analysis of ACC’s PINNACLE registry reveals important gaps in care [news release]. Washington, DC: American College of Cardiology; September 12, 2016. http://www.acc.org/about-acc/press-releases/2016/09/12/14/14/low-statin-use-in-people-with-diabetes-despite-cardioprotective-effects-guidelines?w_nav=S. Accessed September 13, 2016.