Treatment gap in the use of lipid-lowering drug therapy in diabetes: a population-based study.

Abstract

BACKGROUND:

Lowering cholesterol is highly effective in reducing morbidity and mortality in high-risk people with prevalent cardiovascular disease.

AIMS:

To investigate lipid-lowering therapy use for secondary prevention of coronary heart disease in all diabetic patients in Tayside, Scotland.

METHODS:

Among the 385,500 Tayside residents on 31 March 2001, the DARTS database identified all people with Types 1 and 2 diabetes with prevalent macrovascular disease, defined as a history of angina or coronary heart disease. The uptake of lipid-lowering drug was ascertained from MEMO's database of prescriptions dispensed at Tayside pharmacies.

RESULTS:

Among the 1128 Type 1 patients, 11.3% had prevalent macrovascular disease and 7.9% used lipid-lowering therapy with 42.2% for patients with macrovascular disease. Current/former smokers (OR 2.40, 95% CI: 1.15-5.03) and those with a history of coronary heart disease (OR 2.26, 95% CI: 1.04-4.90) were more likely to use lipid-lowering therapy. Among the 8686 Type 2 patients, 38.8% had prevalent macrovascular disease and 18.3% used lipid-lowering therapy, with 26.7% for patients with macrovascular disease. Current/former smokers (OR 1.37; 95% CI 1.17-1.61) and those with a history of coronary heart disease (OR 2.07, 95% CI 1.66-2.59) or angina (OR 1.30, CI 1.03-1.63) were more likely to use lipid-lowering therapy. A duration of 4 years or less from the first macrovascular event was associated with increased use (OR 1.27; 95% CI 1.05-1.54). Age > 70 years reduced the likelihood (OR 0.51, CI 0.44-0.60).

CONCLUSION:

A clear gap exists between those requiring lipid-lowering drug therapy and those who are actually receiving it in Tayside.

• Authors: P James, H H Tan, R MacAlpine, G Brennan, A Emslie-Smith, A D Morris
• Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med) Vol. 21 Issue 10 Pg. 1108-12 (Oct 2004) ISSN: 0742-3071 [Print] England
• PMID: 15384958 (Publication Type: Journal Article)

Chemical References

• Hypolipidemic Agents

Topics

• Adult
• Aged
• Coronary Disease (prevention & control)
• Cross-Sectional Studies
• Diabetes Mellitus, Type 1 (drug therapy)
• Diabetes Mellitus, Type 2 (drug therapy)
• Diabetic Angiopathies (prevention & control)
• Female
• Humans
• Hyperlipidemias (drug therapy)
• Hypolipidemic Agents (therapeutic use)
• Male
• Middle Aged
• Patient Acceptance of Health Care (statistics & numerical data)
• Scotland