Nearly two out of five people with diabetes who could benefit from statin therapy were not prescribed one, according to a research letter published Sept. 12 in the Journal of the American College of Cardiology. The analysis, which uses data from ACC’s PINNACLE Registry, also showed wide variation in statin use across cardiology practices.

Yashashwi Pokharel, MD, MSCR, and colleagues examined practice-level variations in statin therapy among 40-75 year old patients with diabetes and no overt cardiovascular disease between May 2008 and October 2013 – before the present guidelines were issued. A total of 215,193 patients from 204 cardiology practices were included in the study.

The researchers found that 38 percent of patients with diabetes were not taking a statin. Compared with patients not receiving statins, those on statins had a higher prevalence of cardiovascular risk factors, were more likely to receive non-statin cholesterol-lowering therapy (28 vs. 13 percent) and had lower mean LDL cholesterol (LCL-C) readings (90 mg/dL vs. 103 mg/dL). The gaps in treatment and the facility-level variation by LDL-C levels <100 mg/dL were very similar to the main study results (57.7 and 47 percent, respectively), which suggests the findings are not just related to which guideline is used to measure quality. Another reason for lower statin use could also be due to a lack of documentation regarding statin intolerance in some patients, they explain.

The researchers conclude that the findings underscore the urgent need to intensify national efforts to improve guideline-concordant use of statins in patients with diabetes. They add that moving forward, patients and providers should talk about how to prevent a myocardial infarction, stroke or related death at every future opportunity.

“When these types of discussions happen, patients are more likely to receive evidence-based therapies including statins,” said Salim Virani, MD, PhD, an author of the study. “Once one is prescribed, it’s important that patients take them and report any problems to their health care provider.”

Keywords: Cholesterol, LDL, Diabetes Mellitus, Health Personnel, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Prevalence, Registries, Risk Factors, Stroke, National Cardiovascular Data Registries, PINNACLE Registry

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