title: Risk factors for lack of statin therapy in patients with diabetes and coronary artery disease.
abstract: Patients with both diabetes and coronary artery disease (CAD) have exceedingly high cardiovascular risk. Nevertheless, little is known about prevalence of statin therapy in this population and reasons why some patients may not be receiving this potentially life-saving treatment.
  
  
  
  To investigate prevalence and predictors of statin therapy in patients with combined diabetes and CAD.
  
  
  
  We conducted a retrospective cohort study of primary care patients with diabetes and CAD followed at 2 academic medical centers between 2000 and 2011. We used multivariable logistic regression to identify patient and provider characteristics associated with (1) statin initiation (any history of statin therapy) and (2) statin persistence (active statin prescription at the study end).
  
  
  
  Of 8488 study patients, 7427 (87.5%) ever received statins and 6212 (73.2%) had persistent statin therapy. Younger age (odds ratio [OR], 1.26 per decade), smoking (OR, 1.49) and cardiologist evaluation (OR, 2.26) were associated with statin initiation (P < .0001 for all). Younger age (OR, 1.17), family history of CAD (OR, 1.39), no adverse reactions to statins (OR, 1.40; P < .0001 for all), female sex (OR, 1.22; P = .005), history of smoking (OR, 1.22; P = .003), cardiologist evaluation (OR, 1.23; P = .002), and lower HbA1c (OR, 1.04; P = 0.003) were associated with persistent statin therapy. Only 362 (29.8%) of the 1215 patients without persistent statin therapy had tried at least 2 statins, and 58 (4.8%) tried 3 statins.
  
  
  
  Many patients with combined CAD and diabetes are not treated with statins, although in this very high-risk group, even moderate-intensity statins result in meaningful reductions in cardiovascular events. Higher cardiovascular risk and cardiologist evaluation were associated with higher prevalence of statin therapy.
authors.affiliation: Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Department of Endocrinology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Huabing
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Plutzky
authors.affiliation: Division of Endocrinology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Shubina
authors.affiliation: Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA. Electronic address: aturchin@bwh.harvard.edu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Turchin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000473:pathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking
chemical_list: D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Coronary artery disease; Diabetes mellitus; Risk factors; Statins; Therapy