Cardiovascular disease guideline adherence and self-reported statin use in longstanding type 1 diabetes: results from the Canadian study of longevity in diabetes cohort

• Published in: Cardiovascular diabetology Vol. 15; no. 1; p. 14
• Main Authors: Bai, Johnny W, Boulet, Geneviève, Halpern, Elise M, Lovblom, Leif E, Eldelekli, Devrim, Keenan, Hillary A, Brent, Michael, Paul, Narinder, Bril, Vera, Cherney, David Z I, Weisman, Alanna, Perkins, Bruce A
• Format: Journal Article
• Language: English
• Published: England BioMed Central 25.01.2016
• Subjects: Aged; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Canada; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Chi-Square Distribution; Cross-Sectional Studies; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - therapy; Diet - adverse effects; Dyslipidemias - diagnosis; Dyslipidemias - drug therapy; Dyslipidemias - epidemiology; Exercise; Female; Guideline Adherence; Health Care Surveys; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Logistic Models; Longevity; Male; Medication Adherence; Middle Aged; Motor Activity; Multivariate Analysis; Odds Ratio; Original Investigation; Practice Guidelines as Topic; Primary Prevention - methods; Risk Factors; Risk Reduction Behavior; Secondary Prevention - methods; Self Report; Smoking - adverse effects; Smoking Cessation; Smoking Prevention; Time Factors; Treatment Outcome
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-015-0318-9

Older patients with longstanding type 1 diabetes have high cardiovascular disease (CVD) risk such that statin therapy is recommended independent of prior CVD events. We aimed to determine self-reported CVD prevention guideline adherence in patients with longstanding diabetes. 309 Canadians with over 50 years of type 1 diabetes completed a medical questionnaire for presence of lifestyle and pharmacological interventions, stratified into primary or secondary CVD prevention subgroups based on absence or presence of self-reported CVD events, respectively. Associations with statin use were analyzed using multivariable logistic regression. The 309 participants had mean ± SD age 65.7 ± 8.5 years, median diabetes duration 54.0 [IQR 51.0, 59.0] years, and HbA1c of 7.5 ± 1.1 % (58 mmol/mol). 159 (52.7 %) participants reported diet adherence, 296 (95.8 %) smoking avoidance, 217 (70.5 %) physical activity, 218 (71.5 %) renin-angiotensin-system inhibitor use, and 220 (72.1 %) statin use. Physical activity was reported as less common in the secondary prevention subgroup, and current statin use was significantly lower in the primary prevention subgroup (65.5 % vs. 84.8 %, p = 0.0004). In multivariable logistic regression, the odds of statin use was 0.38 [95 % CI 0.15-0.95] in members of the primary compared to the secondary prevention subgroup, adjusting for age, sex, hypertension history, body mass, HbA1c, cholesterol, microvascular complications, acetylsalicylic acid use, and renin-angiotensin system inhibitor use. Despite good self-reported adherence to general CVD prevention guidelines, against the principles of these guidelines we found that statin use was substantially lower in those without CVD history. Interventions are needed to improve statin use in older type 1 diabetes patients without a history of CVD.