title: Statin use and cardiovascular risk factors in diabetic patients developing a first myocardial infarction.
abstract: BACKGROUND
  The risk for a first myocardial infarction (MI) in people with diabetes has been shown to be as high as the risk for a new MI in non-diabetic patients with a prior MI. Consequently, risk-reducing statin therapy is recommended for nearly all patients with diabetes 40 years of age or older, regardless of cholesterol level. The purpose of this study was to assess the recommended and real-life use of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in diabetic patients who develop ASCVD.
  
  
  METHODS
  In a cross-sectional multicenter study of consecutive patients without previous ASCVD hospitalized with a first MI in 2010-2012, we obtained information on diabetic status, statin use, and cardiovascular risk factors prior to MI.
  
  
  RESULTS
  The study population consisted of 1622 patients with first MI (63 % men), 228 of whom had known diabetes before MI. All but three of the diabetic patients were ≥40 years of age. Diabetic patients were older (70 vs 68, p = 0.006), were more often women (43 vs 36 %, p = 0.05) and had a higher prevalence of statin use (47 vs 11 %, p < 0.001) compared with non-diabetic patients. Despite a high risk factor burden, the majority (53 %) of patients with known diabetes was not treated with statins before MI, and there was no relationship between the number of high-risk markers and statin use. Nearly all diabetic patients not treated with statins before first MI had at least one marker of very high cardiovascular risk, including hypertension (71 %), current smoking (37 %), and nephropathy (33 %).
  
  
  CONCLUSIONS
  Primary prevention with statins had been initiated in less than half of diabetic patients destined for a first MI, despite the presence of one or more markers of very high cardiovascular risk in nearly all. These results highlight an urgent need for optimizing statin therapy and global risk factor control in diabetic patients.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus, Denmark. Martin.bodtker.mortensen@clin.au.dk.
authors.forename: Martin Bødtker
authors.initials: MB
authors.lastname: Mortensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus, Denmark.
authors.forename: Imra
authors.initials: I
authors.lastname: Kulenovic
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus, Denmark.
authors.forename: Erling
authors.initials: E
authors.lastname: Falk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology*; D011322:Primary Prevention; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; Diabetes; Myocardial infarction; Prevention; Statin