Age thresholds set for statins in diabetes
GPs should aim to prescribe statins to all men with diabetes over the age of 40 and all women over the age of 45, a major new study concludes.
These are the ages when patients with type 2 diabetes are most likely to make the transition from low to moderate risk for cardiovascular disease, the researchers found.
Their study, to be presented at the Diabetes UK annual conference in Glasgow next week, predicted initiating statins in men at 40 and women at 45 could avoid 11,094 cardiovascular events over five years.
Only 25 patients would need to be treated over the five years to prevent a single cardiovascular event.
Researchers analysed electronic records of some 60,000 patients with diabetes in 229 GP practices in England and Wales, and extrapolated their results to mirror the estimated national prevalence of 3.6 per cent.
Dr Iskandar Idris, consultant in diabetes, endocrinology and internal medicine at Newark Hospital in Nottinghamshire, said: 'The strategy is highly
effective and efficient for reducing cardiovascular events in primary care.'
Dr Roger Gadsby, a GP in Nuneaton, Warwickshire, and associate clinical professor at the University of Warwick
medical school, said offering statins from the suggested age thresholds was sensible.
'For the large majority of patients with type 2 diabetes, the evidence base for considering statin therapy is strong. The much bigger, more complex question is at what age do you stop giving statins?'
A second study to be presented at the conference is set to further help GPs prioritise care for diabetes after researchers developed a new risk engine using data from the UK Prospective Diabetes Study.
The tool, validated by Professor Rury Holman, director of the Diabetes Trials Unit at the University of Oxford, correctly estimated CVD events in 169 of 189 observed cases.
It uses a combination of age, sex, ethnicity, HbA1c, systolic blood pressure, HDL cholesterol ratio and atrial fibrillation.
Dr Gadsby, who is also treasurer of the Primary Care Diabetes Society, said the UKPDS was already a valuable clinical tool for assessing CVD risk, and any improvements to it 'would certainly be very welcome'.
Targeting statins in diabetes
• 60,258 patient records from 229 practices
• 11,005 (18.3 per cent) were aged 30 to 74 with diabetes
• Statins beneficial in men aged above 40.6 years and women aged above 44.2 years
• Strategy would avoided 11,094 CVD events over five years in UK
• 581 out of 3,475 UKPDS patients had a CVD event
• 169 of 189 patients in the CARD study had a CVD event
• Significantly associated risk factors were age, sex, ethnicity, HbA1c, systolic blood pressure, total-to-HDL cholesterol ratio and atrial fibrillation