Adherence to Guideline-directed High-intensity Statin Therapy in Patients with Type 2 Diabetes
Ogechukwu Egini1, Carla Boutin-Foster2, Tina Adjei-Bosompem2, Nicole Mastrogiovanni1, Orlando Sola1, Milena Rodriguez-Alvarez1, Moro Salifu1, 4. Fasika Tedla1, Lorraine Thomas2. 1Internal Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States, 2Office of Diversity and Research, SUNY Downstate Medical Center, Brooklyn, New York, United States
Purpose of Study The 2013 ACC/AHA guideline on blood cholesterol treatment recommended high-intensity statin for individuals 40 - 75 years with estimated 10-year ASCVD ≧ 7.5%. This consideration was based on a recognition that individuals with diabetes are at significantly elevated risk of cardiovascular death. Cardivascular disease was responsible for >40% mortality in New York State in 2014, with Brooklyn neighborhoods bearing the most disease burden. Little data is available about primary prevention in diabetic patients who meet the guidelines for high-intensity statin therapy. The aim of this study is to determine statin use among high-risk patients with Type 2 diabetes.
Methods Used 95 Central Brooklyn patients with Type 2 diabetes were enrolled over a 6-month period. We obtained demographic information, including age, gender and smoking history. A chart review provided latest lab data and medications with doses. We also measured the blood pressure of all enrolless. All study participants were African-American. We calculated the cardiovascular risk profile per participant with help of the ACC/AHA heart risk calculator. Using a logistic regression model, we stratified our study participants with estimated risk ≧7.5% into those receiving appropriate statin therapy and those that are not. Appropriate therapy was defined as those getting high-intensity statin as recommended which is either Rosuvastatin 20 or 40mg or Atorvastatin 40 or 80mg dose.
Summary of Results 57 (60%) were females. Significantly more males smoked in comparison to females (p<0.001). All 95 enrollees had a calculated heart risk score ≧7.5% thus required high-intensity statin therapy as per ACC/AHA guidelines. The median ASCVD risk score was significantly higher in males than in females (p<0.001). Our study showed that a significant number of enrollees were not on appropriate statin therapy (p<0.05). Gender did not contribute to inappropriate statin therapy (p>0.05).
Conclusions The study showed that there was poor appropriate statin therapy for primary prevention of cardiovascular death among Central Brooklyn patients with Type 2 diabetes suggesting a need to encourage Providers to recognize risks and initiate recommended statin therapy.
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