Care gaps in achieving cholesterol targets in people with diabetes: A population-based study in a universal health care setting. (February 2022) - Butalia, Sonia
Highlights: 1/3 of individuals did not achieve LDL-C targets in a universal health care setting. Several characteristics were associated with being more likely to achieve targets. These were: older age, males, comorbidities, better adherence & higher intensity users. Strategies are needed to fill the population gap of achieving target levels of LDL-C. This is necessary if the benefits of statins shown in trials are to be achieved. Abstract: Aims: Statins are first line therapy in people with diabetes. Little is known about real-world statin intensity use and low-density lipoprotein cholesterol (LDL-C) levels achieved. We aimed to describe statin intensity used, achievement of LDL-C targets, and factors associated with achieving targets among adults with diabetes. Methods: This population based (∼4.3 million), retrospective observational study, used clinical and administrative databases. Statin use by intensity, adherence, and achievement of LDL-C targets in adults with diabetes were described. Multiple logistic regression assessed the factors associated with achieving targets. Results: Out of 331, 312 individuals with diabetes, 88% had an index LDL-C test. At follow up, 31% overall did not achieve LDL-C targets and overall adherence was 66%. Failure to achieve targets was 49%, 30%, and 25% in low-, moderate-, and high-intensity statin groups, respectively. Those who were older, males, had a history of myocardial infarction, stroke, congestive heart failure, renal disease, better adherence, and higher intensity statin users were more likely to achieve targets. Conclusions: One-third of people on statins did not achieve targets. Strategies to fill the gap between ideal and current levels of LDL-C achieved are needed if the benefits of statins demonstrated in trials are to be translated into practice.