Pragmatic and early usage of statin in patients with diabetes for prevention of atherosclerotic cardiovascular disease: Survey-based opinions of indian health-care practitioners

Sanjay Kalra; Surender Kumar; Kaushik Pandit; R Anantharaman; Atul Dhingra; I Periyandavar; Manoj Chawla; Mohan Magdum; Piyush Desai; Prasun Deb; Senthil Kumar Rajasekaran; Ramesh N Nair; Shehla Shaikh; Subodh Banzal; Sunil Kota; Tejas Shah; Santosh Y Revankar; Amit Gupta

doi:10.4103/cdrp.cdrp_CDRP_18_22

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ORIGINAL ARTICLE

Year : 2023 \| Volume : 2 \| Issue : 1 \| Page : 4-12

Pragmatic and early usage of statin in patients with diabetes for prevention of atherosclerotic cardiovascular disease: Survey-based opinions of indian health-care practitioners Sanjay Kalra¹, Surender Kumar², Kaushik Pandit³, R Anantharaman⁴, Atul Dhingra⁵, I Periyandavar⁶, Manoj Chawla⁷, Mohan Magdum⁸, Piyush Desai⁹, Prasun Deb¹⁰, Senthil Kumar Rajasekaran¹¹, Ramesh N Nair¹², Shehla Shaikh¹³, Subodh Banzal¹⁴, Sunil Kota¹⁵, Tejas Shah¹⁶, Santosh Y Revankar¹⁷, Amit Gupta¹⁷ ¹ Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India ² Department of Endocrinology, Ganga Ram Hospital, New Delhi, India ³ Department of Endocrinology, Fortis Hospital, Kolkata, West Bengal, India ⁴ Magna Clinics for Obesity Diabetes and Endocrinology, Bengaluru, Karnataka, India ⁵ Department of Endocrinology, Gangaram Bansal Hospital, Sri Ganganagar, Rajasthan, India ⁶ Saroja Diabetic Centre, Chennai, Tamil Nadu, India ⁷ Lina Diabetes Centre, Mumbai, Maharashtra, India ⁸ Poona Hospital and Research Centre, Pune, Maharashtra, India ⁹ Advanced Diabetes Centre, Surat, Gujarat, India ¹⁰ Department of Endocrinology, KIMS Hospital, Hyderabad, Telangana, India ¹¹ Department of Endocrinology, PSG Hospitals, Coimbatore, Tamil Nadu, India ¹² Department of Endocrinology, Bharath Hospital, Kottayam, Kerala, India ¹³ KGN Diabetes and Endocrine Centre, Mumbai, Maharashtra, India ¹⁴ Obesity Thyroid and Hormone Research Center and Gyane Clinic, Indore, Madhya Pradesh, India ¹⁵ Diabetes and Endocare Clinic, Brahmapur, Odisha, India ¹⁶ IVA Speciality Clinic and Diabetes Care Centre, Mumbai, Maharashtra, India ¹⁷ Medical Services, USV Private Limited, Mumbai, Maharashtra, India Correspondence Address: Santosh Y Revankar USV Private Limited, Mumbai, Maharashtra India Source of Support: This project has been funded by USV Pvt. Ltd, Conflict of Interest: Dr. Santosh Revankar and Dr. Amit Gupta are employees of USV Pvt Ltd. All other authors have no conflicts of interest to declare DOI: 10.4103/cdrp.cdrp_CDRP_18_22

Background: An early initiation of statins in the diabetes population helps in prevention of atherosclerotic cardiovascular disease (ASCVD). However, there is a paucity of data on its use in young Indian patients with diabetes. This survey report aimed to provide opinion-based recommendations for pragmatic usage of statin in diabetes population of India. Material and Methods: Discussion and virtual survey (a questionnaire of 18 questions) was conducted at 16 round table meetings (RTMs) which included participation of health-care practitioners (HCPs) from India. On the basis of their opinions and discussion, general recommendations about early usage of statins in diabetes for prevention of ASCVD were derived. Results: Out of 261 HCPs participated, 56.1% recommended initiating statins in patients aged 41–50 years irrespective of their total/low-density lipoprotein cholesterol (LDL-C) levels. Among people with diabetes aged between 20 and 39 years, 38.9% of HCPs considered LDL-C >100 mg/dL and 77% of HCPs considered history of ASCVD as a risk factor for early statin initiation. Overall, 98.9% of HCPs agreed that early initiation of statin in people with diabetes and ASCVD risk factors will help reduce ASCVD. The majority of HCPs recommended initiating moderate-intensity (51.2%) and low-intensity (43.8%) statins and assess every 3 months for tolerance and compliance in people with diabetes (aged 20–39 years) and additional ASCVD risk factors. The use of rosuvastatin (78.5% of HCPs) was preferred for early initiation in people with diabetes. Majority of HCPs agreed (57.3%) or strongly agreed (36.2%) that rosuvastatin has more clinical utility compared to other statins due to better LDL-C-lowering effect and other pleiotropic effects. Physician's inertia limits the effective use of statins among young adults with diabetes (55.8%), and 65.8% of HCPs recommended screening of people with diabetes for additional ASCVD risk factors. Conclusion: The participating HCPs opined that early initiation of statin therapy in people with diabetes and ASCVD risk factors will help reduce ASCVD. Rosuvastatin is mostly recommended for early initiation of statin therapy among the diabetes population for prevention of ASCVD. There is a necessity of using a proactive approach to screen for additional ASCVD risk factors in young individuals with diabetes and further increase the awareness about benefits of initiating statin therapy from an early stage.



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