National guidelines now recommend that most adult patients with diabetes should be prescribed a statin to reduce the risk cardiovascular disease and death. But cardiology practices prescribed a statin for only 62% of diabetic patients, according to an analysis published September 14, 2016 in the Journal of the American College of Cardiology. The analysis also showed that statin prescribing patterns varied widely among the 204 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,” said senior author Salim Virani, MD, PhD, Cardiologist at the Michael E. DeBakey VA Medical Center and Associate Professor at Baylor College of Medicine in Houston, TX. “In this study, we found 38% of patients with diabetes were not on a statin, which can be lifesaving.”
To lower diabetic patients’ risk of developing cardiovascular disease (CVD), the American College of Cardiology and the American Heart Association issued guidelines in 2013 stating that, unless contraindicated, statin therapy should be started and maintained in 40- to 75-year-old patients with diabetes whose LDL cholesterol level is 70 mg/dL or higher.
The American Diabetes Association similarly recommends that people with diabetes ages 40 and older should be prescribed a statin to supplement lifestyle changes, regardless of baseline LDL cholesterol levels or whether they have CVD.
For this analysis, Dr. Virani and colleagues reviewed medical records data taken from the American College of Cardiology’s PINNACLE registry between May 2008 and October 2013 (before the current guidelines were issued). The analysis included a total of 215,193 patients, who had diabetes and no CVD, from 204 cardiology practices (582,048 encounters).
Results showed that patients who did not receive statins—compared with those who did—had a lower prevalence of cardiovascular risk factors, were less likely to receive non-statin cholesterol-lowering therapy (13% vs. 28%), and had higher mean LDL cholesterol readings (103 mg/dL vs. 90 mg/dL).
In addition, cardiology practices varied widely in deciding which patients they prescribed a statin. After adjusting for age, gender, race, hypertension, dyslipidemia, tobacco use, and insurance coverage, cardiology practices’ prescribing patterns varied up to 57% between two similar patients, researchers found.
“Such wide variation illustrates the gap between guideline recommendations and real-world practice,” Dr. Virani said. “Health care providers manage similar diabetes patients differently. While some variation is OK, what we found is concerning and may ultimately affect clinical outcomes.”
The researchers’ next step is to identify barriers to statin use and to test electronic medical record alerts and decision-support tools at the point of care in order to improve guideline-driven statin use and thereby reduce cardiovascular risks.
For now, providers and patients should take every opportunity to talk to about how to prevent a heart attack, stroke, or related death in the future. “When these types of discussions happen, patients are more likely to receive evidence-based therapies including statins,” Dr. Virani explained. “Once one is prescribed, it’s important that patients take them and report any problems to their health care provider.”