Achieving target cholesterol levels in diabetic patients: Potency of the statin or potency of the physician?

Michal Shani*, Julian Dresner, Shlomo Vinker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The introduction of more potent statins such as atorvastatin and rosuvastatin in Israel was accompanied by massive advertising about their superiority. Objectives: To assess the need for switching therapy from older statins to more potent ones among diabetic patients with uncontrolled hypercholesterrolemia. Methods: Data on all diabetic patients over 30 years old attending two urban clicnics were extracted and analyzed. For each patient we checked the last low density lipoprotein-cholesterol measurements for the year 2006, the brand and the dose of cholesterol-lowering medications, prescriptions and actual purchasing over a 4 month period prior to the last LDL-C measurement, and whether treatment changes were necessary to achieve the LDL-C target (100 mg/dl or 70 mg/dl). Results: The study population comprised 630 patients, age 66.7 ± 12.6 years, of whom 338 (53.6%) were women. Of the 533 (84.6%) patients whose LDL-C was measured in 2006, 45 (8.1%) had levels < 70 mg/dl and 184 (33.3%) had levels of 70 mg/dl < LDL-C < 100 m/dl. The reasons for LDL-C > 100 mg/dl were patents not prescribed cholesterol-lowering drugs (38.3%), partial compliance (27.2%), and under-dosage of statins (15.4%); only 7.7% needed to switch to a more potent statin. Reasons for LDL-C > 70 mg/dl were patients not prescribed cholesterol-lowering drugs (34.3%), partial compliance (22.0%), and under-dosage of statins (26.6%); only 8.7% needed to switch to a more potent statin. Conclusions: Only a small minority of diabetic patients with uncontrolled hypercholesterolemia need one of the potent statins as the next treatment step. More emphasis on compliance and dose adjustment is needed to achieve the target LDL-C level.

Original languageEnglish
Pages (from-to)354-357
Number of pages4
JournalIsrael Medical Association Journal
Volume10
Issue number5
StatePublished - May 2008

Keywords

  • Daibetes control
  • Diabetes mellitus
  • HMG-CoA reductase
  • Low density lipoprotein-cholesterol
  • Primary care

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