Evaluation of statin indication and dose intensification among type 2 diabetic patients at Tikur Anbessa Specialized Hospital

Abstract

Background Diabetes Mellitus (DM) increases the incidence and mortality of cardiovascular diseases (CVD) by a 2 to 4-fold compared to people without DM. Although clinical practice guidelines recommend the use of statin in type 2 DM (T2DM) patients to reduce cardiovascular risks and all-cause mortality, statin intolerance and other factors may lead to treatment discontinuation, switching among statin agents, dose adjustments, or the need for augmentation of the statin regimen impacting therapeutic benefits and patient outcomes. This study aimed to assess the appropriateness of indication and dose intensification of statin therapy among T2DM patients at Tikur Anbessa Specialized Hospital (TASH). Methodology : A hospital-based cross-sectional study design was conducted among 405 T2DM patients from 01 April to 30 June 2020. A systematic random sampling technique was implemented to recruit study participants who had been on follow-up during the study period in TASH. Adjusted odds ratio (OR) was used to measure the association of dependent and independent variables at 95% confidence interval (CI) and P-values of < 0.05 were utilized to determine the statistical significance. Results Statins were initiated for 85.4% of patients. Majority (82.9%) of patients were indicated statin for primary prevention and the estimated 10-year ASCVD scores were ≥ 7.5% among 60.1% of patients. Among 346 patients on statin therapy, the indication was appropriate in 333 (96.2%) patients while 216 (62.4%) patients were appropriately intensified. Predictors for appropriateness of statin indication were ASCVD score ≥ 7.5% (AOR = 0.275; 95% CI: 0.102–0.738, p = 0.01), presence of dyslipidemia (AOR = 4.48; 95%CI: 1.85–10.84; p = 0.001), initiation of aspirin therapy (AOR = 3.7; 95%CI: 1.522–9.144; p = 0.004), and LDL-cholesterol level 70–189 mg/dL (AOR = 0.124; 95% CI:0.042–0.365; p = 0.001). Moreover, duration of illness (AOR = 3.22, 95% CI: 1.680-6.1351, P < 0.001) and history of vascular complications (AOR = 3.24, 95% CI: 1.085,9.708, P = 0.035) were associated with inappropriate dose intensification of statins. Conclusion The study found that indication of statins was generally in line with guidelines, but inappropriate statin dose intensification was linked to patients with longer duration of diabetes and vascular complications. Clinicians should consider dose titration of statins based on patient cardiovascular risk profile and routine laboratory results.