Prevalence and predictors of statin utilization among patient populations at high vascular risk in Ghana

Appropriate Use of Primary Statin Preventive Therapy Among Patients with High Atherosclerosis-Related Cardiovascular Disease Risks: Cross-Sectional Study, Northeast Ethiopia

Background

Atherosclerosis-related cardiovascular diseases (coronary heart diseases, ischemic stroke, and peripheral vascular diseases) account for the majority of deaths in diabetic and other high-risk patients. Statin therapy reduces major vascular events, coronary death or nonfatal myocardial infarction, coronary revascularization, and ischemic stroke. However, a gap exists between guideline recommendations and the clinical practice of primary statin preventive therapy. This was a cross-sectional study that aimed to determine the prevalence and some associated risk factors of.

Purpose

This study was intended to assess the magnitude of primary statin preventive therapy and associated factors among patients with high atherosclerosis-related cardiovascular disease risks.

Patients and Methods

An institutional-based cross-sectional study design was conducted by a consecutive sampling technique from February 1, 2023, to May 30, 2023. Face-to-face interviews using a structured questionnaire, document review, and laboratory measurements were implemented to collect data. Data entered into Epi Data were analysed by STATA version 14 and summarized by using frequency tables and graphs. Binary and multivariate logistic regression analyses were performed and checked for association at a p value of <0.05.

Results

A total of 389 patients were included in this study. Diabetes mellitus (43.75%), hypertension (47.3%), and chronic kidney disease (9.25%) were commonly identified diseases. One hundred sixty-seven (42.93%, CI: 38.07-47.92) patients with high atherosclerosis-related cardiovascular disease (ASCVD) risks were on primary statin preventive therapy. Duration of diabetes mellitus (AOR=1.33, CI: 1.1569-1.528), treating physician (AOR=3.875, CI: 1.368-10.969), follow-up regularity (AOR=3.113, CI: 1.029-9.417) and ten-year atherosclerosis-related cardiovascular disease risk score (AOR=1.126, CI: 1.021-1.243) were found to be significantly associated with the use of primary statin preventive therapy.

Conclusion and Recommendations

The magnitude of patients who were on primary statin preventive therapy was relatively low (42.93%). Improving the regular follow-up and making senior physicians (internists) attend patients at medical follow-up clinics would likely improve the number of patients who are on primary statin preventive therapy.

Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients attended at Jugol General Hospital in eastern Ethiopia: A cross-sectional study

Background

Most clinical practice guidelines support the use of statins in patients with type 2 diabetes mellitus to lower the risk of cardiovascular disease. However, nothing is known about the prescribing patterns of statins at Jugol General Hospital in eastern Ethiopia.

Objective

This study aimed to assess the prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients attended at Jugol General Hospital in eastern Ethiopia.

Methods

A retrospective cross-sectional study was conducted among 423 patients with type 2 diabetes mellitus who received follow-up care from 1 June 2017 to 1 June 2022. The study participants were enrolled consecutively using a convenience sampling technique. The data were extracted from patients' medical records using a data abstraction checklist. The extracted data were entered into EpiData, version 3.1, and exported to Statistical Package for the Social Sciences (SPSS), version 22, for analysis. Associations were considered to be statistically significant at a p-value < 0.05 and presented as adjusted odds ratios and 95% confidence intervals.

Result

The medical records of 423 patients were reviewed. The review revealed that medical records were complete for 410 of these patients, and these records were included in the analysis. The majority of the study participants were female (72.2%) and between the age of 40 and 65 years (61.2%). All of the study participants were eligible for statin prescription; however, statins were prescribed for only 257 (62.7%) study participants. Of the statins prescribed, moderate-dose-intensity statins were prescribed for 40 (15.6%) participants who were at high risk of cardiovascular disease. Atorvastatin was the most commonly (93.3%) prescribed statin. The presence of hypertension, coronary artery disease, and cerebrovascular events was significantly associated with statin prescribing.

Conclusion

The magnitude of prescribing statins for patients with type 2 diabetes mellitus was low in comparison with the clinical practice guidelines recommendation. This finding is alarming and is a call for action to improve the execution of clinical practice guidelines for the benefit of this high-risk population.

Differential associations between pre-diabetes, diabetes and stroke occurrence among West Africans

BACKGROUND

There are limited data from Africa on the burden and associations between pre-diabetes (pre-DM), diabetes mellitus (DM) and stroke occurrence in a region experiencing a profound rise in stroke burden.

PURPOSE

To characterize the associations between stroke and dysglycemic status among West Africans.

METHODS

The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with clinical and radiological evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular factors were performed. Pre-diabetes was defined as HBA1c of 5.7%-6.4% or Fasting blood glucose (FBG) 5.6-7.0 mmol/L and DM as HBA1c >6.5% or FBG>7.0 mmol/L. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval.

RESULTS

Among 2,935 stroke cases the mean age was 60.0 ± 14.2 years with 55.2% being males. By glycemic status, 931 (31.7%) were euglycemic, 633 (21.6%) had Pre-diabetes and 1371 (46.7%) had DM. Of the age- and sex-matched stroke-free controls 69.2% were euglycemic, 13.3% had pre-DM and 17.5% had DM. Pre-DM [aOR (95% CI): 3.68(2.61-5.21)] and DM [4.29 (3.19-5.74)] were independently associated with stroke. The aOR of Pre-DM for ischemic stroke 3.06 (2.01-4.64)] was lower than 4.82 (3.37-6.89) for DM. However, the aOR of Pre-DM for hemorrhagic stroke 6.81 (95% CI: 3.29 - 14.08)] was higher than 3.36 (1.94-5.86) for DM. Furthermore, the aOR of pre-DM for ischemic stroke subtypes were 9.64 (1.30-71.57) for cardio-embolic stroke, 3.64 (1.80-7.34) for small-vessel occlusive disease and 4.63 (0.80-26.65) for large-vessel disease.

CONCLUSION

Pre-DM is strongly and independently associated with stroke in Africans. Improving glycemic control through screening, healthy lifestyle and pharmacotherapy at a population level may be strategic in reducing the rising burden of stroke in Africa.

Prevalence and factors associated with lipid-lowering medications use for primary and secondary prevention of cardiovascular diseases among Malaysians: the REDISCOVER study

Background

Lipid-lowering medications (LLM) are commonly used for secondary prevention, as well as for primary prevention among patients with high global cardiovascular risk and with diabetes. This study aimed to determine the prevalence of LLM use among high-risk individuals [participants with diabetes, high Framingham general cardiovascular (FRS-CVD) score, existing cardiovascular disease (CVD)] and the factors associated with it.

Methods

This is a cross-sectional analysis from the baseline recruitment (years 2007 to 2011) of an ongoing prospective study involving 11,288 participants from 40 rural and urban communities in Malaysia. Multiple logistic regression was used to identify characteristics associated with LLM use.

Results

Majority (74.2%) of participants with CVD were not on LLM. Only 10.5% of participants with high FRS-CVD score, and 17.1% with diabetes were on LLM. Participants who were obese (OR = 1.80, 95% CI: 1.15–2.83), have diabetes (OR = 2.38, 95% CI: 1.78–3.19), have hypertension (OR = 2.87, 95% CI: 2.09–3.95), and attained tertiary education (OR = 2.25, 95% CI: 1.06–4.78) were more likely to be on LLM. Rural residents had lower odds of being on LLM (OR = 0.58, 95% CI: 0.41–0.82). In the primary prevention group, participants with high FRS-CVD score (OR = 3.81, 95% CI: 2.78–5.23) and high-income earners (OR = 1.54, 95% CI: 1.06–2.24) had higher odds of being on LLM.

Conclusions

LLM use among high CVD-risk individuals in the primary prevention group, and also among individuals with existing CVD was low. While CVD risk factors and global cardiovascular risk score were positively associated with LLM use, sociodemographic disparities were observed among the less-educated, rural residents and low-income earners. Measures are needed to ensure optimal and equitable use of LLM.

Statin Prescription Patterns and Associated Factors Among Patients with Type 2 Diabetes Mellitus Attending Diabetic Clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania

PURPOSE

To determine statin prescription patterns and associated factors among type 2 diabetes patients attending the diabetic clinic at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.

PATIENTS AND METHODS

A hospital-based cross-sectional study involving outpatients was conducted from September 2020 to November 2020. Statin prescription history (both type and dosage) was obtained from patients as well as from the electronic medical records for determination of patterns. Participants were categorized as moderate or high risk for cardiovascular disease whereas prescription patterns were categorized as moderate and high intensity statins. Logistic regression was used to examine association, control confounders and effect modifier whereby p <0.05 was considered statistically significant.

RESULTS

Of 400 patients who were approached for the study, 395 (98.8%) were eligible for statin prescriptions. The mean (±SD) age of the study participants was 58.1±10.3 years, out of which 371 (93.9%) belonged to the age group ≥40 years. Two-thirds(241 61.0%) of the patients were female. About two-thirds(257; 69.4%) of patients had health insurance coverage. Statins were prescribed in 47.3% of the participants. Moderate intensity statin was the only pattern prescribed. In the adjusted model, insurance coverage (OR: 0.056; 95% CI: 0.03-0.12), and hypertension (OR: 0.259; 95% CI: 0.12-0.54) were associated with an increased likelihood of being prescribed a moderate intensity statin.

CONCLUSION

A significant number of patients at MNH diabetic clinic were not on statins despite qualifying for the prescription. The findings call for further studies on reasons for low statin prescription practices in this tertiary facility.

Adherence to Clinical Guidelines on STATIN Prescribing Among Diabetic Patients Aged 40-75 Years Old in a Primary Care Setting: A Cross-Sectional Study

BACKGROUND

Diabetes mellitus (D.M.) is a chronic metabolic disease caused by decreased insulin secretion, which increases the risk of cardiovascular diseases. Evidence has shown that statins reduce cardiovascular risk in patients with diabetes; moreover, most clinical guidelines recommend statins.

OBJECTIVE

This study aimed to assess the level and status of adherence to guidelines on statin prescription in patients with diabetes mellitus in a primary care setting in Palestine.

METHODS

A retrospective cross-sectional descriptive study was conducted at an ambulatory center in Palestine. Data were collected by auditing prescription records and reviewing medical charts of patients with diabetes who visited the clinic from February 15 to March 17, 2021. The collected data included patient characteristics, comorbidities, lipid profiles, and statin prescription. A chi-square test was used to evaluate the appropriateness of the prescribed statins with different demographic and clinical variables. Statistical significance was set at p < 0.05. Statistical Package for Social Sciences (SPSS) version 22 was used to analyze the data.

RESULTS

Out Of 262 diabetic patients included in the analysis, 74% were prescribed appropriate statin therapy according to the American Diabetes Association (ADA) guidelines, and 24% of patients had inappropriate statin therapy or needed statins. Furthermore, 82.8% were on high-intensity statins, while 11% were not taking any statins. More than 60% of patients had uncontrolled diabetes and hypertension.

CONCLUSION

Most guidelines recommend statin therapy in diabetic patients owing to its benefits in preventing cardiovascular complications. In this study, most patients were on appropriate STATIN therapy; however, 50% of diabetic patients had LDL of more than 100 mg/dl, and 25% were not prescribed statins, increasing their risk of ASCVD. Therefore, we recommend strict adherence to the established guidelines on statins prescribed to patients with diabetes to prevent cardiovascular complications, save lives, and reduce healthcare costs.

Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa

Background The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies. Purpose To quantify the magnitude and direction of the effect sizes of key modifiable stroke risk factors according to three age groups: <50 years (young), 50-65 years (middle age) and > 65 years (elderly) in West Africa. Methods This was a case-control study involving 15 sites in Ghana and Nigeria. Cases included adults aged ≥18 years with CT/MRI scan-typed stroke. Controls were age-and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. We estimated adjusted odds ratios (aOR) using conditional logistic regression and population attributable risk (PAR) with 95% Confidence Interval of vascular risk factors by age groups. Results Among 3553 stroke cases, 813 (22.9%) were young, 1441 (40.6%) were middle-aged and 1299 (36.6%) were elderly. Among the 5 co-shared risk factors, dyslipidemia with PAR and aOR (95%CI) of 62.20% (52.82-71.58) and 4.13 (2.64-6.46) was highest among the young age group; hypertension with PAR of 94.31% (91.82-96.80) and aOR of 28.93 (15.10-55.44) was highest among the middle-age group. Diabetes with PAR of 32.29%(27.52-37.05) and aOR of 3.49 (2.56-4.75); meat consumption with PAR of 42.34%(32.33-52.35) and aOR of 2.40 (1.76, 3.26); and non-consumption of green vegetables, PAR of 16.81%(12.02-21.60) and aOR of 2.23 (1.60-3.12) were highest among the elderly age group. However confidence intervals of risk estimates overlapped across age groups. Additionally, among the young age group cigarette smoking, psychosocial stress and cardiac disease were independently associated with stroke. Furthermore, education, stress, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group. Conclusion There is a differential influence of age on the associations of major risk factors with stroke in this West African cohort. Targeting modifiable factors predominant within an age group may be more effective as a stroke prevention strategy.

Factors associated with incidence of stroke and heart failure among people living with HIV in Ghana: Evaluating Vascular Event Risk while on Long-Term Antiretroviral Suppressive Therapy (EVERLAST) Study

People living with HIV (PLWH) have a two‐fold higher risk of cardiovascular diseases (CVDs) compared with HIV‐negative populations. Although 70% of the global HIV population reside in Africa, data on CVD outcomes among PLWH are scarce. We seek to evaluate factors associated with incidence of stroke and heart failure in a prospective cohort of Ghanaian PLWH. We followed up a cohort of PLWH on antiretroviral therapy for 12 months to assess rates of clinically adjudicated stroke, and heart failure. We calculated incidence rates of events/1000 person‐years and fitted Cox proportional hazards regression models to identify factors associated with incident stroke and heart failure as a combined outcome measure and as separate outcome measures. Among 255 participants, the mean age was 46 years and 211 (82.7%) were female. The participants contributed 245 years of follow‐up data with mean follow‐up duration of 11.5 months. There were three incident strokes giving an incidence rate of 12.24 per 1000 person‐years (95% CI: 3.13–33.33) and two heart failure events with an incidence rate of 8.16 (95%CI: 1.37–26.97) per 1000 py. The combined event rate was 20.41 (95% CI: 7.48–45.24) per 1000 py. Being hypertensive was associated with aHR of 8.61 (1.32–56.04) of the combined outcome while each 100 cells/mm³ rise in CD4 count was associated with aHR of 0.56 (0.35–0.88). Carotid bulb intimal media thickness was independently associated with stroke occurrence with aHR of 12.23 (1.28–117.07). People living with HIV on long‐term cART in this Ghanaian sample have high rates of clinically adjudicated cardiovascular diseases driven by uncontrolled hypertension and persisting immunosuppression. Integration of CVD care into routine HIV management may help alleviate this untoward confluence of rising CVDs among PLWH.

Atherosclerotic event risk and risk reduction therapies among Ghanaian hemorrhagic stroke survivors

BACKGROUND

Intracerebral hemorrhage (ICH) stroke constitute up to 40% of incident strokes in Africa. While ICH patients are at high risk for atherosclerotic events, the risk-benefit of anti-atherosclerotic therapies in this patient population is uncertain.

PURPOSE

To assess whether utility of statins and/or antithrombotic agents after surviving an ICH correlates with atherosclerotic risk of an observational cohort.

METHODS

We analyzed data in a stroke registry prospectively collected on consecutively encountered stroke survivors seen at an out-patient clinic in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details, including diagnosis of ICH, co-morbidities, and key atherosclerotic risk reduction therapies (statins and anti-platelet drugs). We computed ischemic vascular risk using the Framingham Risk Score (FRS) to classify patients into low, intermediate and high vascular risk.

RESULTS

Of 1101 stroke survivors seen during the period, 244 (22.2%) had ICH. Vascular risk profiles were low (n = 86; 35.2%), intermediate (n = 71; 29.1%) and high (n = 87; 35.7%). Utility of statin use was 76.7% (low risk), 84.5% (intermediate risk), and 87.4% (high risk), p = 0.16 while antiplatelet use trended with atherosclerotic risk being 9.3% (low risk), 25.4% (intermediate risk), and high risk (34.5%), p = 0.0004. Independent factors associated with statin use were hypertension (OR 8.80; 95% CI: 2.34-33.11) and cigarette smoking (OR 0.29; 95% CI: 0.09-0.89) while antiplatelet drug use was associated with age (OR 1.43; 95% CI: 1.06-1.92) and time from index stroke (OR: 1.02; 95% CI: 1.01-1.02).

CONCLUSION

Approximately two-thirds of ICH survivors in this African sample had intermediate to high risk of future atherosclerotic events. Clinical trials on the timing, safety, and efficacy of statins and antiplatelet drugs among ICH survivors could help better guide risk mitigation in this population.