Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
Type 1 and statins: patients with type 1 diabetes should not be excluded when considering statin therapy.
Numerous previous studies have evaluated the necessity of statins as dyslipidemia therapy in patients with type 2 diabetes. However, there has not been much research on the treatment that lowers lipids in patients with type 1 diabetes. The goal of this BMJ article was to conduct a risk assessment of cardiovascular disease by studying the adherence to lipid-lowering medications in the desired patient population. With dyslipidemia being preventable and controllable by lifestyle modifications that also reduce cardiovascular disease, it is essential to know how decreasing lipids could impact patients with type 1 diabetes.
This Swedish longitudinal retrospective study was population-based and lasted for four years with a three year follow up. Between 2006 and 2010, 6192 adult patients with type 1 diabetes received lipid-lowering treatment. Demographics including comorbidities, history of cardiovascular disease and statin therapy, and socioeconomic wellbeing were collected. Exclusion criteria consisted of established users of statins before the study and combination medication regimens with lipid-lowering capabilities except for bile acid sequestrants. Medication adherence was measured by using patients’ refill histories to calculate a medication possession ratio after 18 months into the study. Patients forgoing their prescribed treatment for 180 days or longer were defined as nonpersistent. The follow up was conducted into December 2013 to observe patients who experienced cardiovascular disease or fatalities. Statistical analysis in this study included cox regression analysis in determining the level of compliance or non-persistence to the prescribed lipid-lowering medications and assessing whether those factors are correlated with risk in cardiovascular disease. The results were adjusted per the patients’ socioeconomic class and the probability of cardiovascular complications.
The mean medication possession ratio was reasonably high at 72%, with a little above 50% of those patients having a score higher than 80%. About 27% decided to discontinue the lipid-lowering treatment. Fifty-eight cardiovascular disease-related events were fatal, and 637 were nonfatal with a follow up mean of three to four years. A medication possession ratio higher than 80% was correlated with a lower risk for cardiovascular disease that was nonfatal compared to lower ratios (HR 0.78; 95% CI 0.65 to 0.93). For a cardiovascular disease that was life-terminating, there was a negative association with increased Adherence. However, this was not found to be statistically significant (HR 1.96; 95% CI 0.96 to 4.01). Results showed that those who discontinued the designated treatment intervention were at an increased risk of nonfatal cardiovascular disease HR 1.43 (95% CI 1.18 to 1.73). In this study, which was conducted nationwide, adults with type 1 diabetes using statins were found to have a 22% decrease for nonfatal cardiovascular disease. In contrast, patients who discontinued the treatment intervention had a 43% increase in developing a nonfatal cardiovascular complication. This work argues that statins should not only be recommended in patients with type 2 diabetes.
To conclude, patients with type 1 diabetes have a lower risk of cardiovascular disease, not resulting in death with increased medication adherence to lipid-lowering therapies similar to that of a patient with type 2 diabetes. The risk tends to rise when patients discontinue the treatment and was seen in just 18 months within this study. It is crucial to encourage and facilitate the patient’s understanding of adhering to their medication regimens, especially when dealing with the population who has diabetes. This may make the difference in the patients achieving goals in treatment and preventing cardiovascular complications or death. Limitations for this research include possible confounding that could result from unforeseen circumstances like a history of familial disease or psychiatric conditions, which would impact the patients’ ability to adhere to therapy. Also, a patient’s refill history does not translate to the person’s consumption of said medication, which was assumed in this observational study. Thus, compliance may have been overestimated. Future studies could involve a more thorough examination of the patients’ past medical history and habits.
Practice Pearls:
- Shorter life expectancy in patients with type 1 diabetes is most common in those who suffer from cardiovascular disease.
- Initiating treatment that can lower lipids in patients with type 1 diabetes can reduce the risk of cardiovascular disease when patients adhere to the medication.
- Disruption in the statin medication regimen shows a higher risk of cardiovascular complications.
Hero C, Karlsson SA, Franzén S, et al. Adherence to lipid-lowering therapy and risk for cardiovascular disease and death in type 1 diabetes mellitus: a population-based study from the Swedish National Diabetes Register. BMJ Open Diabetes Res Care. 2020;8(1).
Mia Flowers, PharmD. Candidate of Florida Agricultural & Mechanical University School of Pharmacy