Lipid-lowering treatment for all could substantially reduce the burden of macrovascular complications of diabetes patients in the Netherlands.
BACKGROUND
We aimed to quantify the potential health benefits of increased use of lipid-lowering treatment (LLT), according to current guidelines, for the Dutch diabetes population.


METHODS
Simulation study.


METHODS
We compared the long-term health outcomes for a scenario in which all diabetes patients received LLT to those in a 'current practice' scenario, in which 28% received LLT. The model reflected the Dutch diabetes population 40-80 years of age, in 2003. Sensitivity analyses were performed, using more conservative assumptions.


RESULTS
Over the lifetime, LLT for all diabetes patients reduced the expected cumulative incidences of coronary heart disease (CHD) and stroke by, respectively, 6 and 9%. Average life expectancy of Dutch diabetes patients would increase by 0.33 years, ranging from 0.14 years for patients aged 70-79 years, to 0.84 years for patients aged 40-49 years at the start of the simulation. Life-long treatment for patients aged 50-59 contributed most to the life years gained (55,000 out of 146,000). With reduced effectiveness of LLT and fewer patients starting LLT, the cumulative incidences of both CHD and stroke would decrease by approximately 2%. The number needed to treat to prevent one incident case of cardiovascular disease over lifetime was 20 for CHD and 44 for stroke.


CONCLUSIONS
This simulation study shows that increased use of LLT can substantially reduce the expected future burden of CHD and stroke in the Dutch diabetes population.
Jacobs-van der Bruggen
Monique A M
MA
Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. Monique.Jacobs@rivm.nl
Engelfriet
Peter M
PM
Hoogenveen
Rudolf T
RT
van Baal
Pieter H M
PH
Struijs
Jeroen N
JN
Verschuren
Wilhelmina M M
WM
Smit
Henriette A
HA
Baan
Caroline A
CA
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003198:Computer Simulation; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004363:Drug Utilization; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008017:Life Expectancy; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015203:Reproducibility of Results; D013997:Time Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors