19-LB: Statin Use as a Primary Prevention in Patients with Type 1 Diabetes: Where Do We Stand?

Type 1 diabetes (T1D) carries a high cardiovascular risk (CVD). Statins reduce risk of non-fatal myocardial infarction when used as primary prevention in selected patients[1]. We reviewed 205 electronic records of patients with T1D at our center from July 2019 to September 2019. We followed 2018 NICE guidelines for statin use as a primary prevention for our analysis (1)age ≥40 years (2)diabetes duration ≥10 years (3)established nephropathy (4)established other CVD risks.

Our cohort consisted of 119 males (58%) with a mean BMI of 25.5±4.4 kg/m² and mean age of 43±16 years. The median duration of diabetes was 16 [IQR 8 - 27] years. More than 50% of our patients had attended “Dose Adjustment For Normal Eating, DAFNE” course. Approximately 71% had T1D for ≥10 years and 56% were ≥40 years. Mean systolic and diastolic blood pressures were 128 (±15.3) mmHg and 77 (±10) mmHg, respectively. Mean LDL was 2.4 (±0.74) mmol/L. In total 24.8% were on statin therapy, 2.4% on fibrates and 4.4% declined statin. Of the patients reviewed, 180 (87.8%) met the criteria for primary prevention; however, of those 51/180 (28.3%) were on statin, 44/146 (30.1%) with diabetes ≥10 years, 46/115 (40.0%) ≥40, 34/93 (36.6%) with established retinopathy. Regarding macro and microvascular complications, 3.4% had CAD, 6.8% chronic kidney disease (eGFR<60) and 47.8% retinopathy. Patients with T1D have higher CVD risk, for which statin therapy is advised[2, 3]. Our patients are undertreated with statins as primary prevention.

References: 1.Cholesterol Treatment Trialists’, C., et al., Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet (London, England), 2010. 376(9753): p. 1670-1681.2.De Ferranti, S.D., et al., Type 1 Diabetes Mellitus and Cardiovascular Disease. Circulation, 2014. 130(13): p. 1110-1130.3.Sharma, H., et al., Cardiovascular disease in type 1 diabetes. Cardiovascular endocrinology & metabolism, 2019. 8(1): p. 28-34.