Results The total number of participants whose data was collected in the six clinics was 300. Of this, 127 were female and 173 were male. The average age of the participants was 54.83 years. The participants were prescribed different lipid lowering drugs with some patients taking a regimen of two drugs. Additionally, the information collected included the individual patient’s cholesterol and triglycerides levels. This was meant to
evaluate whether the cholesterol and triglycerides level affect the choice of lipid lowering drug prescribed and how this compares with evidence. Table 1.0 below shows the distribution of the participants according to the drug prescribed and age.
Figure 1.0 Distribution of patients according to age and treatment
Legend – Graphical representation of age of patients and treatment prescription. Unk (Unknown), A (Atorvastatin), b (bezafibrate), f (fenofibrate) and S (Simvastatin)
Legend – Graphical representation of Gender distribution and treatment. Unk (Unknown), A (Atorvastatin), b (bezafibrate), f (fenofibrate) and S (Simvastatin)
There were 127 females and 173 male participants in the study. The medical files did not have information on the drugs prescribed to 81 participants (27%). Of this 45 were female (35.43% of women) and 36 (20.81% of males) were male participants. 33.07% of women participants were prescribed atorvastatin, 0.79% bezafibrate, 1.57% fenofibrate, and 29.13% simvastanin. For the men, 52.60% were prescribed simvastatin, 1.16% fenofibrate, 0.58% bezafibrate, and 24.86% atorvastatin.
Key
<3.4 mmol/L =less than 3.4 mmol/L
> 3.4 mmol/L = more than 3.4 mmol/L
betw 2.6 mmol/L = between 2.6 mmol/L and 1.8 mmol/L
<1.8 mmol/L = less than 1.8 mmol/L
Figure 3.0 LDL-C levels and treatment prescription
Legend – Graphical representation of LDL-C levels and treatment. Unk (Unknown), A (Atorvastatin), b (bezafibrate), f (fenofibrate) and S (Simvastatin)
For the patients with high LDL levels (more than 3.4mmol/L), the most commonly prescribed drugs were atorvastatin (22.08%) and simvastatin (57.14%). Similarly, these drugs were the most commonly prescribed for people with mid levels of LDL measures with atorvastatin prescribed 34.94% and 23.16% and simvastatin prescribed 42.17% and 34.74% for patients with less than 3.4mmol/L and between 2.6 mmol/L and 1.8 mmol/L respectively.
Key
<1.6mmol/L = less than 1.6mmol/L
>= 1.6mmol/L = greater or equal to 1.6 mmol/L
Figure 4.0 HDL-C levels and treatment prescription
Legend – Graphical representation of HDL-C levels and lipid lowering drugs. Unk (Unknown), A (Atorvastatin), b (bezafibrate), f (fenofibrate) and S (Simvastatin)
Majority of the patients with less than 1.6mmol/L HDL were prescribed atorvastatin (28.37%) and simvastatin (40.07%). For the patients with HDL levels that are greater than or equal to 1.6 mmol/L, the major drugs prescribed were bezafibrate (27.78%) and fenofibrate (61.11%). All the patients who had missing prescriptions had a HDL level of less than 1.6mmol/L.
Key
<1.7mmol/L = less than 1.7mmol/L
>= 1.7mmol/L = more than 1.7mmol/L
Figure 5.0 Triglyceride Levels and treatment prescription
Legend – Graphical representation of triglyceride levels and lipid lowering drugs. Unk (Unknown), A (Atorvastatin), b (bezafibrate), f (fenofibrate) and S (Simvastatin)
For the patients with triglycerides levels that are greater than or equal to 1.7mmol/L, the main drugs prescribed were simvastatin (48.17%) and atorvastatin (26.22%) compared to fenofibrate (1.22%) and bezafibrate, which was prescribed 0.61% of the times. For the patients with triglycerides levels that were less than 1.7mmol/L, simvastatin was prescribed 25.74% of the times, astovarstatin 27.94% of the time, fenofibrate 1.47 % of the time and bezafibrate 0.74% of the time. In this group, the records did not indicate the lipid lowering drug prescribed to 41.91% of the patients.
Summary of prescription to control cardiovascular risk in type 2 diabetes patients
Patients selected 300
Patients with established cardiovascular risk 300
Patients with missing prescription Patients prescribed with lipid lowering drugs 81 (27%) 219(73%)
Prescribed with statins and combination Other drugs * 213(71%) 6 (2%)
Simvastatin (Sim) Atorvastatin (Ato) Sim + Bezafibrate Sim + Fenofibrate Ato + Fenofibrate
114 (38%) 81 (27%) 5 (1.66%) 8 (2.66%) 5(1.66%)
*other drugs include Bezafibrate and Fenofibrate
The summary chart indicates clearly that a significant amount of type 2 diabetic patients are under maintenance dose of statins to prevent further cardiovascular risk.
Statistics of patients reaching the target with lipid lowering treatment
LDL >2.6 mmol/L
This clearly suggests that statins are the choice of drug and among combination simvastatin + Fenofibrate are the best choice.
Triglyceride >1.7 mmol/L
This clearly suggests that statins are the choice of drug and among combination of simvastatin + Fenofibrate is the best choice.
