Statin prescribing varies in patients with diabetes

Wide variation exists in practice-level statin prescribing for patients with diabetes, according to a new study.

The study, conducted by Yashashwi Pokharel, MD, MSCR, and colleagues, was published as a research letter in the September 20 issue in the Journal of the American College of Cardiology.

The researchers collected from electronic medical record data in the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) registry, a national cardiology outpatient quality improvement registry. Researchers analyzed statin use in patients 40 to 75 years old with diabetes and no cardiovascular disease (CVD) between May 2008 and October 2013. After evaluating appropriate patients, researchers assessed practice-level rates of statin-prescribing, variation in statin prescribing in diabetic patients and attempted to determine how much of this variation could be explained by patient versus practice-level factors. 

According to the American Diabetes Association, all people with diabetes should take either moderate or high doses of statins, in keeping with guidelines from the American College of Cardiology and American Heart Association, which state that patients with diabetes aged 40 to 75 years should be on moderate to high-intensity statin therapy.

Results of the study determined that, among 215,193 patients from 204 cardiology practices, statins were prescribed in only 61.6% of patients with diabetes. Furthermore, statin prescribing varied by up to 57% across clinical practices after adjusting for patient-specific factors.

Virani

“Our findings are that close to 40% of the patients with diabetes (but without any cardiovascular disease) are not on a statin and there is a wide practice-level variation in statin prescribing,” according to senior author Salim S Virani, MD, PhD, from Michael E DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Texas.

These findings emphasize that team-based approaches are needed to improve evidence-based statin use in patients with diabetes, according to Virani.

“Therefore, patients, healthcare providers and formulary managers will all need to work together to address this,” he says. “This may include a diabetic patient bringing up the issue of cardiovascular disease prevention, a healthcare provider asking the question as to what needs to be done to decrease a patient’s risk of cardiovascular disease, and ensuring the formulary choices for various statins are available to treat patients with diabetes.”

Importantly, the study determined that adjustment for patient-related variables did not change the rate of variation in statin prescribing for patients with diabetes, suggesting that practice- or provider-related factors primarily determined the variation in statin use, Virani says.

“Diabetic patients and their providers should both discuss at each visit what evidence-based interventions can reduce future risk of cardiovascular events,” he says. “From a system’s perspective, having formulary choices for various statins would be very helpful. This will ensure that if patients are not able to tolerate a statin due to side effect, then other formulary choices are available for their healthcare provider to choose from.”