title: Cardiovascular disease guideline adherence and self-reported statin use in longstanding type 1 diabetes: results from the Canadian study of longevity in diabetes cohort.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Johnny W
authors.initials: JW
authors.lastname: Bai
authors.affiliation: 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.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Boulet
authors.affiliation: 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.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Halpern
authors.affiliation: 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.
authors.forename: Leif E
authors.initials: LE
authors.lastname: Lovblom
authors.affiliation: 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.
authors.forename: Devrim
authors.initials: D
authors.lastname: Eldelekli
authors.affiliation: Research Division, Joslin Diabetes Center, Boston, MA, USA. hillary.keenan@joslin.harvard.edu.
authors.forename: Hillary A
authors.initials: HA
authors.lastname: Keenan
authors.affiliation: Department of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto, Toronto, ON, Canada. michael.brent@uhn.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Brent
authors.affiliation: Joint Department of Medical Imaging, Division of Cardiothoracic Radiology, University Health Network, Toronto, ON, Canada. narinder.paul@uhn.ca.
authors.forename: Narinder
authors.initials: N
authors.lastname: Paul
authors.affiliation: 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.
authors.forename: Vera
authors.initials: V
authors.lastname: Bril
authors.affiliation: Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada. david.cherney@uhn.ca.
authors.forename: David Z I
authors.initials: DZ
authors.lastname: Cherney
authors.affiliation: 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.
authors.forename: Alanna
authors.initials: A
authors.lastname: Weisman
authors.affiliation: 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.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Perkins
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002170:Canada; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004032:Diet / Q000009:adverse effects; D050171:Dyslipidemias / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015444:Exercise; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008136:Longevity; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods*; D057566:Self Report; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
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