THE PREVALENCE OF STATIN PRESCRIPTION FOR PRIMARY PREVENTION OF ARTERIOSCLEROTIC CARDIOVASCULAR DISEASE AMONG PATIENTS WITH TYPE 2 DIABETES IN QATAR

Abstract

Background: Qatar has one of the highest prevalence rates for diabetes in the world. Arteriosclerotic cardiovascular diseases (ASCVDs) are responsible for nearly 50% of deaths among patients with diabetes in Qatar. Treating with statins is a simple and effective approach for preventing ASCVD among patients with diabetes. Local and international guidelines recommend the use of statins for primary prevention of ASCVD in patients with diabetes, especially for those 40-75 years of age. Yet statins are still under-prescribed to diabetic individuals for primary prevention of ASCVD worldwide, especially in primary care settings which is where most of the medical management of diabetes occurs. Little is known about the prevalence of statin prescription for primary prevention of ASCVD among diabetics in primary care settings in Qatar. Objectives: To measure the proportion of T2dm patients receiving statins for primary prevention of ASCVD in primary care settings and to investigate patients' characteristics associated with statin prescription. Methods: A cross sectional review of electronic medical records of patients with T2dm 40-75 years of age, treated in any of the 27 health centers operated by Primary Healthcare Corporation, the largest primary care provider in the country, during calendar year 2019. A multivariable logistic regression model was used to estimate the odds of being prescribed statins and to adjust for confounding variables. Results: Of 23,934 patients with complete data, 57% were males and 31.9% were Qatari nationals. Average age for participants was 54.8 ± 8.25 years. 66 % of the patients received statins at least once during the year 2019. The statin prescription rate for Non-Qatari males was 70.1% and was significantly higher than non-Qatari females, Qatari females, or Qatari males (62.2%, 62.9% and 63.9% respectively P value <0.000) In a multivariable model analysis and after controlling for other covariates in the model, statin prescription was positively associated with being male (adjusted odds ratio (aOR): 1.2, [95% CI: 1.12-1.28]), history of smoking, i.e. former smoker (aOR 1.16 [95% CI: 1.03-1.29]), current smoker (aOR 1.11 [95% CI: 1.01-1.22 ]), associated diagnosis of hypertension (aOR 1.51 [95% CI: 1.41-1.61]), being prescribed other non-statin lipids lowering medications (aOR 1.44 [95% CI: 1.27-1.63]), increased age (aOR 1.03/year [95% CI: 1.026-1.034]), increasing daily pill burden (aOR 1.23/pill [95% CI: 1.21-1.25]), increasing number of daily medication injections (aOR 1.29/injection [95% CI: 1.23-1.35]), and frequent visits to GP clinic (aOR 1.22/visit [95% CI: 1.19-1.24]). Statin prescription was negatively associated with having a history of diabetic neuropathy (aOR 0.87 [95% CI: 0.75-1.0]), increasing BMI (aOR 0.996/unit [95% CI: 0.9892-1.00]), being Qatari (aOR 0.87 [95% CI: 0.81-0.93]) or being prescribed an anti-platelet (aOR 0.96/unit [95% CI: 0.89-1.03]). Significant negative effect modification between hypertension and either male gender or Qatari nationality was found, further lowering the odds for Qatari males. Conclusion: Prevalence of statin prescription for primary prevention of ASCVD among patients with T2dm was suboptimal in primary care settings in Qatar and need to be improved. Factors associated with a lower prevalence of statin prescription namely female gender and Qatari nationality needs to be addressed. Further studies are needed to explore causes of the low prescription rates of statins in Qatar.