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Combining Population Health and Baseline Risk strategy by determining an age cut-offs for initiating statins in patients with diabetes: A population-based study

¹ Sherwood Forest Hospitals Foundation Trust, UK
² Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, UK
³ Trent RDSU, University of Nottingham, UK
⁴ Northern General Hospital, Sheffield
⁵ Sheffield Hallam University, Sheffield, UK

iidris{at}aol.com

ABSTRACT

Objective:Strategies for initiating statins among adult patients with diabetes for primary CVD prevention include treating all patients (assuming diabetes is a coronary risk equivalent) or treating patients who are at risk of developing CVD. The aim of the study was to combine both strategies to derive an appropriate age cut-off for prescribing statins. By considering different strategies, we also aim to assess the effectiveness and the efficiency of different strategies to reduce CVD events.

Design:Cross-sectional primary care population study using electronic patient files from 304 general practitioner practices in England and Wales. Out of 60258 patients with diabetes, 11005 men and women aged 30-74 years fulfil criteria for primary CVD prevention. Model outcomes were extrapolated to an estimated national diabetes prevalence of 3.6%.

Results:The age transition from low-risk to moderate-risk category for diabetic men and women occurred at ages 40.6 and 44.2 years respectively, sensitivity and specificity for fulfilling moderate CVD risk criteria were 97.9% and 61.8% for men and 92.0% and 77.0% for women. When applied to the national population, the age cut-off strategies was an effective and efficient strategy, potentially avoiding 11094 events with number need to treat of 25.1.

Conclusions:A strategy to treat all men and women with diabetes above the age of 40 and 45 respectively with statins showed good compromise between high effectiveness and high efficiency for reducing CVD events in patients with diabetes. Strategy to intervene if cholesterol>5mmol/l was the least effective and efficient in preventing CVD events

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