Variability in Statin Use Seen Among Finnish T2D Population

Results of a retrospective cohort study revealed many patients with type 2 diabetes (T2D) in Finland do not receive appropriate cholesterol-lowering treatment, as researchers identified significant variations between low-density lipoprotein cholesterol (LDL-C) trajectories regarding LDL-C development as well as measurement activity and statin treatment.

Findings published in Scientific Reports indicate physicians “should increase efforts to achieve the LDL-C treatment targets—especially in the patient group with constantly elevated LDL-C levels—by paying attention to earlier initiation of statin treatment, intensification of treatments when necessary and re-initiating if possible,” authors wrote.

Elevated LDL-C levels are strongly associated with an increased risk of atherosclerotic cardiovascular diseases among patients with T2D, while regular follow-ups and optimal control of glycated hemoglobin, LDL-C, and blood pressure can help prevent or delay complications.

“International and national guidelines have consistently identified statins as the principal lipid-lowering therapy, recommended particularly at moderate- to high-intensity,” researchers explained.

In an effort to identify potential gaps in current diabetes management among patients in the Finnish region of North Karelia, investigators used data from regional electronic health records (EHRs) recorded between 2012 and 2017.

A total of 8592 patients with T2D were included in analyses (53.8% men; 46.2% women) and all participants had a mean disease duration of under 8 years; over the course of the follow-up window, 15.1% of men and 13.5% of women died.

“At baseline, women achieved the LDL-C treatment target < 2.5 mmol/L less often than men (50.8% vs 55.7%, respectively; P < .001) and were less often on any statin treatment (56.1% vs 60.1%, respectively; P < .001),” authors wrote. They used a growth mixture model to identify 4 LDL-C trajectory groups.

Analyses revealed:

• The majority of patients (85.9%) had “moderate-stable” LDL-C levels around 2.3 mmol/L
• The second-largest group (7.7%) consisted of predominantly untreated patients with alarmingly “high-stable” LDL-C levels around 3.9 mmol/L
• The “decreasing” group (3.8%) was characterized by large improvements in initially very high LDL-C levels, along with the highest statin treatment intensification rates
• Among patients with “increasing” LDL-C (2.5%), statin treatment declined drastically
• In all the trajectory groups, women had significantly higher average LDL-C levels and received less frequent any statin treatment and high-intensity treatment than men

Throughout the follow-up period, the proportion of patients receiving any statin treatment declined among men from around 42% to 27% and in women from 34% to 23%, respectively. At the end of the study window, 41.9% of patients had no statin prescribed.

Overall, “women had worse LDL-C control, were less often prescribed statin, or had it prescribed at a lower intensity, and exhibited treatment discontinuations more often than men,” researchers said.

These gender differences could be due to differences in statin dosages, adherence, pathophysiology, or pharmacodynamics. Thyroid diseases are associated with higher LDL-C and are also more common among women with T2D compared with men.

The dataset included in this analysis did not include individuals who exclusively used private health care services or information on socioeconomic factors, diet, or physical activity, marking limitations.

“The results of our study may support physicians to identify patients who need to be monitored more closely beyond a single time point measurement,” authors concluded.

Reference

Inglin L, Lavikainen P, Jalkanen K, and Laatikainen T. LDL-cholesterol trajectories and statin treatment in Finnish type 2 diabetes patients: a growth mixture model. Sci Rep. Published online November 19, 2021. doi: 10.1038/s41598-021-02077-6