Diabetes, Metabolic Syndrome and Obesity (Mar 2024)
Evaluation of Statin Indication and Dose Intensification Among Type 2 Diabetic Patients at a Tertiary Hospital
Abstract
Pineal Yitbarek Fisseha,1 Assefa Mulu Baye,2 Melak Gedamu Beyene,2 Eyasu Makonnen2 1Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Assefa Mulu Baye, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251910980410, Email [email protected]: Diabetes mellitus (DM) increases cardiovascular disease (CVD) incidence and mortality. While guidelines endorse statin use in type 2 DM (T2DM) to mitigate cardiovascular risks and mortality, challenges like statin initiation and prompt treatment adjustments affect patient outcomes. This study aimed to assess the appropriateness of indications for and dose intensification of statin therapy among T2DM patients at Tikur Anbessa Specialized Hospital (TASH).Methodology: A hospital-based cross-sectional study was conducted from April 1 to June 30 2020. In total, 405 T2DM patients were selected using a systematic random sampling technique. The data were analyzed using SPSS version 26.0. An adjusted odds ratio (OR) was used and a 95% confidence interval (CI) and p-values of < 0.05 were utilized to determine statistical significance.Results: Of the total 405 participants, 346 (85.4%) started taking statins for primary or secondary prevention purposes. Indication for statin use was appropriate in 96.2% patients, while for 216 (62.4%) patients their doses were appropriately intensified. Predictors of the inappropriateness of statin use were an atherosclerotic cardiovascular disease (ASCVD) score of ≥ 7.5% (AOR=0.28; 95% CI: 0.102– 0.738, p=0.01), the presence of dyslipidemia (AOR=4.48; 95% CI: 1.85– 10.84; p=0.001), initiation of aspirin therapy (AOR=3.7; 95% CI: 1.522– 9.144; p=0.004), and an LDL-cholesterol level of 70– 189 mg/dL (AOR=0.124; 95% CI: 0.042– 0.365; p=0.001). DM duration of ≥ 10 years (AOR=2.51; 95% CI: 1.35– 4.66, p=0.004), male gender (AOR=2.04; 95% CI: 1.16– 3.58, p=0.013), age ≥ 65 years (AOR=2.15; 95% CI: 1.23– 3.75, p=0.007) and uncontrolled blood pressure (AOR=2.09; 95% CI: 1.07– 4.08, p=0.031) were associated with inappropriate statin intensification.Conclusion: The study found that indication of statins was optimal and about two-thirds of patients had their doses appropriately intensified. Monitoring is needed to avoid inappropriate intensification of statin therapy, particularly in patients with longer diabetes duration, those of male gender and advanced age, and those with uncontrolled blood pressure.Keywords: atherosclerotic cardiovascular disease, diabetes mellitus, statin therapy
