Statin therapy among diabetic patients in Rwanda

Abstract

Background: We conducted a cross-sectional study of 384 outpatients diabetics aged between 40-75 years attending 2 teachings hospitals (CHUK and CHUB), and one private Rwanda diabetic association clinic were included in the study for a period of 3 months, since April until June 2022. We assessed the percentage of eligible diabetic patients taking statins, and patients were divided into groups for primary or secondary prevention based on their prior history of ASCVD. Logistic regression was used to determine the association between primary or secondary statin prescription. Purpose: the study purpose is to assess the extent of statin therapy among study participants for primary and secondary cardiovascular diseases prevention. Results: 384 patients were enrolled in the study; their average age was 58 (+/- 9.8), and 37.2% of them were between 50-60 years. Among the participants, 284 (74%) were females, 378 (98.4%) had insurance, and 253 (65.9%) of the diabetes were hypertensive. The mean (± SD) of ACC/AHA 10 years ASCVD risk scores was found to be 17.06 (±15.51), 204 of participants (66.4%) had a high risk level of 10 years cardiovascular risk and 103(33.6%) had a moderate risk level. Among 384 patients, only 7(1.7 %) were on statins, 3 of 7 (42.8%) as primary prevention and 4 among 7(57.2%) as secondary prevention of atherosclerotic cardiovascular diseases. A binary logistic regression was conducted on variables which were significantly associated from bivariate analysis that include gender, health insurance, atherosclerotic cardiovascular disease and hypertension for controlling for confounding and effect modification. The results revealed that female patients are 10.3 times less likely to receive statin than male patients (AOR=10.35, 95% CI: 1.003-46.865, P=0.042). Non-insured diabetic patients in this study were 2.15 times less likely to receive statin (AOR=2.15, 95% CI: 1.0017.027, P=0.006) than those with insurance scheme. Patients without atherosclerotic cardiovascular disease were 1.602 times less likely to be on statin than those with established ASCVD (AOR=1.602, 95% CI: 1.102 - 4.219, P=0.008). Patients without hypertension were 2.41times less likely to use statin than hypertensive (AOR=2.41, 95% CI: 1.023-8.206, P=0.031). Conclusion: According to the findings of this study, the majority of diabetic patients in Rwanda are not on statin therapy and physicians do not adhere to the international guidelines recommendations on statins therapy among diabetics. These findings call for an improvement in diabetic standard of care by complying with the evidence based guidelines recommendations