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Cardiovasc Diabetol. 2016 Jan 25;15:14. doi: 10.1186/s12933-015-0318-9.

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

Author information

1
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada. jw.bai@mail.utoronto.ca.
2
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada. boulet@lunenfeld.ca.
3
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada. elise.halpern@gmail.com.
4
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada. lovblom@lunenfeld.ca.
5
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada. eldelekli@lunenfeld.ca.
6
Research Division, Joslin Diabetes Center, Boston, MA, USA. hillary.keenan@joslin.harvard.edu.
7
Department of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto, Toronto, ON, Canada. michael.brent@uhn.ca.
8
Joint Department of Medical Imaging, Division of Cardiothoracic Radiology, University Health Network, Toronto, ON, Canada. narinder.paul@uhn.ca.
9
The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada. vera.bril@utoronto.ca.
10
Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada. david.cherney@uhn.ca.
11
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada. alanna.weisman@mail.utoronto.ca.
12
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada. BPerkins@mtsinai.on.ca.

Abstract

BACKGROUND:

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.

RESEARCH DESIGN AND METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

PMID:
26809442
PMCID:
PMC4727297
DOI:
10.1186/s12933-015-0318-9
[Indexed for MEDLINE]
Free PMC Article

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