Author + information
- Nihan Kahya Eren1,
- Ece Harman2,
- Devrim Dolek2,
- Sadık Volkan Emren1,
- Aliye Pelin Tütüncüoğlu2,
- Cem Nazlı1 and
- Oktay Ergene3
Lipid-lowering therapy (LLT) is a key factor in the prevention of cardiovascular mortality and morbidity in diabetic patients. Current guidelines have expanded the population of patients with diabetes for whom aggressive low-density lipoprotein cholesterol (LDL-C) lowering therapy should be considered. This study evaluated the management of dyslipidemia in patients with type 2 diabetes in real life.
Secondary care physicians in a tertiary center recruited 707 patients. The prevalence of statin use along with the achievement of cholesterol targets, predictors for receiving statin, and possible reasons for lack of therapy were investigated.
The mean age of the patients was 58±11.04, and 40% were male. Cardiovascular disease (CVD) was present in 32% (n=225) of the patients. There were 499 patients (71%) who had hypertension (HT), 19% (n=134) had nephropathy, and 23% (n=162) had diabetic retinopathy. Only 33% of the patients were on statin therapy, and this was significantly higher in those with cardiovascular disease (47% versus 27%; p<0.001). Most of the patients had LDL-C levels of > 100 mg/dl (77%), with only 5% having LDL-C levels of < 70 mg/dl. Among patients with CVD, only 7% achieved the target LDL-C levels of < 70 mg/dl. At multivariate analysis the presence of CVD, HT, retinopathy, doing regular physical exercise and being at fifth decade of life were predictors for statin usage (Table 1). Among the patients who were not on statin therapy, 288 (61%) had never been prescribed LLT previously, and 183 patients (39%) had used statins in the past but had stopped using it. The most frequent reason for discontinuation of the statin therapy was a physician's advice to stop the medication. The patients taking statins had similar LDL-C levels as those who had never been prescribed statins and those who had discontinued their use of statins on the advice of a physician (123.0±41.4 vs. 125.1±33.2, p=0.333; 123.0±41.4 vs. 129.0±33.1 mg/dl; p=0.116, respectively).
The majority of diabetic patients are undertreated with statins and minority of them achieve LDL-C target levels. Our findings suggest that there is a large discrepency between evidence-based recommendations and physicians’ treatment attitudes.
|Odds ratio||95% Confidence interval||p value|
|Coronary artery disease||1.51||1.02-2.26||0.039|
|Peripheral artery disease||2.63||1.19-5.84||0.017|
Predictors of statin therapy at multivariate logistic regression analysis