Researchers conducted a retrospective study which revealed that the initiation of statin therapy among diabetic patients who may later develop myocardial infarction is sub-optimal, despite having markers of very high cardiovascular risk.
Myocardial infarctions (MI), or more commonly referred to as heart attacks, occur when the oxygen-rich blood flow to the heart becomes blocked, thus depriving it of the oxygen it needs. This dangerous situation may be caused by atherosclerosis, a condition in which plaque builds up in the arteries over time. This plaque is an accumulation of fatty acids, cholesterol, calcium, and other compounds that together narrow the flow of blood to the heart.
It is widely known that diabetes is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). It was also demonstrated that the risk for a first heart attack among individuals with type 2 diabetes was as high as that for a subsequent heart attack in non-diabetic individuals with a history of myocardial infarction. In response to this, guidelines were established and risk-reducing statin therapy was recommended for patients of concern, in particular those over 40 years old with diabetes. Statins, also known as HMG-CoA reductase inhibitors, are drugs that aim to lower cholesterol by blocking the enzyme necessary for producing this lipid.
As reported in the journal Cardiovascular Diabetology, researchers have conducted a cross-sectional multicenter study to examine the clinical practice of implementing statin therapy. The study involved 1622 patients with an initial MI, 228 (about 14%) of which had diabetes prior to its occurrence. Data was collected from each individual with regards to any known prescribed treatment for diabetes, use of statins and anti-hypertensive drugs, as well as cardiovascular risk burden before initial hospitalization for MI. Myocardial infarction was clinically defined by the evidence of myocardial ischemia (inadequate blood supply) and elevated biomarkers for necrosis (cell death) in the heart. Other cardiovascular risk factors such as blood pressure, age, smoking status, and cholesterol levels were also assessed.
Findings have shown that primary prevention through the use of statin therapy had only been introduced in 47% of the individuals with diabetes and 11% of those without known diabetes, even though almost every patient was considered to be at a very high cardiovascular risk. Nearly all individuals had displayed at least one marker characteristic of a very high cardiovascular risk, such as hypertension, smoking, and nephropathy. A significant portion of individuals not treated with statins before their first MI had experienced hypertension or were smokers. It is accepted that active smoking can increase the risk of type 2 diabetes, ASCVD, and other diabetes-associated implications. Researchers also noted that the prevalence of markers of very high cardiovascular risk was not greater among diabetic, statin-treated individuals as compared to those that were diabetic and untreated.
Overall, the results demonstrate that adherence to guidelines proposed by health programs and agencies are low in clinical practice. Although there are certain limitations to this study, this study nonetheless emphasizes the significant role of primary care providers, since they can effectively improve clinical outcomes when recommendations are implemented appropriately.
Written By: Michelle Tu, BSc