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Journal:
Diabet Med. 2004 Oct;21(10):1108-12
Author(s):
James p, Tan HH, MacAlpine R, Brennan G, Emslie-Smith A, Morris AD.
Contact:
University Department of Clinical Pharmacology, Ninwells Hospital and Medical School, Dundee, UK.
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.
RESEARCH DESIGN AND 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: 1.155.03) and those with a history of coronary heart disease (OR 2.26, 95% CI: 1.044.90) 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 1.171.61) and those with a history of coronary heart disease (OR 2.07, 95% CI 1.662.59) or angina (OR 1.30, CI 1.031.63) 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 1.051.54). Age > 70 years reduced the likelihood (OR 0.51, CI 0.440.60).
CONCLUSIONS:
A clear gap exists between those requiring lipid-lowering drug therapy and those who are actually receiving it in Tayside.