Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Lipid lowering therapy use and achievement of cholesterol targets in an Australian diabetes clinic   (#302)

Katerina Kiburg 1 2 , Glenn Ward 2 3 4 , David O'Neal 2 3 , Richard MacIsaac 2 3
  1. St Vincents Institute, Melbourne, Victoria, Australia
  2. St Vincents Hospital Melbourne, Fitzroy, Victoria, Australia
  3. Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  4. Department of Clinical Biochemistry, St Vincents Hospital Melbourne, Fitzroy, Victoria, Australia

Background:

Patients with diabetes are at a high risk for the development of cardiovascular (CV) disease. Statins have been shown to reduce CV events in direct relationship to their LDL-cholesterol (LDL-C) lowering effect.

Aims:

To document temporal changes in LDL-C levels and the use of lipid lowering medications in patients attending diabetes clinics at St Vincent’s Hospital Melbourne.

Methods:

Information was extracted from a clinic database from 1993 to 2016. Descriptive statistics, student’s T-test, Pearson’s correlation coefficients and chi square test were used to analyse the data with statistical significance at p<0.01.

Results:

The use of lipid lowering therapy increased from 6% to 69% of patients between the time periods 1993-1995 and 2014-2016 (p<0.01, chi-square test). This corresponded to a decrease in LDL-C levels from 3.7 mmol/L to 2.4 mmol/L (p<0.01). There was a strong negative correlation between lipid lowering therapy use and LDL-C levels (r = -0.88, p<0.01). Patients with or without a history of CV disease had a decrease in mean LDL-C from 1993-1995 to 2014-2016 of 3.55 to 2.29 (p<0.01) and 3.67 to 2.52 mmol/L (p<0.01), respectively.

 

Figure 1: Uptake of Lipid Lowering Therapy and Mean LDL-C Results over Time.

The publication dates of major trials in subjects with and without diabetes is also shown.

4S Study1, HPS Study2, CARDS Study3, TNT Study4, JUPITER Study5.

58f948dcf14c2-LDL+and+Statin.png

Conclusions:

There has been a substantial increase in the use of lipid lowering therapies by patients with diabetes over the last 20 years, which has resulted in a significant improvement in LDL-cholesterol levels. The above trends appear to be influenced by the publication of the results from major statin trials.

 

 

  1. 1. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). The Lancet. 1994;344.
  2. 2. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. The Lancet. 2002;360:7-22.
  3. 3. Colhoun H BD, Durrington P, Hitman G, Neil H, Linvingstone S, Thomason M, Mackness M, Charlton-Menys V, Fuller J Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. The Lancet. 2004;364:685-96.
  4. 4. Waters D GJ, Herrington D, McGowan M, Wenger N, Shear C. Treating to new targets (TNT) study: does lowering low-density lipoprotein cholesterol levels below currently recommended guidelines yield incremental clinical benefit? American Journal of Cardiology. 2004;93:154-8.
  5. 5. Ridker P PA, MacFadyen J, Libby P, Glynn R. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. The Lancet. 2012;380:565-71.