People of South Asian and African/African Caribbean ethnicity are more likely than those of European ethnicity to develop type 2 diabetes, as well as cardiovascular disease complications of diabetes such as heart attacks and strokes. A study published in the open access journal PLOS Medicine by Sophie Eastwood at University College London, United Kingdom, and colleagues suggests people of African/ African Caribbean ethnicity with type 2 diabetes and people of South Asian ethnicity were less likely to receive guideline indicated statins than people of European ethnicity. Statin treatment lowers blood cholesterol and reduces cardiovascular complications in people with diabetes.
Type 2 diabetes is a potent risk factor for cardiovascular disease, linked to 17.9 million deaths worldwide per year, 80% of which are due to heart attacks and stroke. Studies suggest ethnic differences exist in statin prescribing for people with diabetes. To investigate ethnic differences in guideline-indicated statin prescribing for people with type 2 diabetes, researchers accessed a database of 12 million anonymized primary care records from 836 practices in the United Kingdom. They identified 31,039 cases of type 2 diabetes diagnosed between 2006 and 2019. They then compared rates of statin initiation for people of European, South Asian and African/ African Caribbean ethnicity, adjusting for differences in socio-demographics, healthcare usage, and cardiovascular risk factors or co-morbidity across the three groups.
The researchers found that people of African/ African Caribbean ethnicity with type 2 diabetes were 24%, and people of South Asian ethnicity 9%, less likely to receive guideline-indicated statins than people of European ethnicity. The study was limited in that the authors were unable to identify specific reasons for the inequity in statin prescribing across different ethnicities. Future studies are needed to fully explain the prescribing disparities across different ethnic groups.
Dr. Eastwood adds, "Statins lower cholesterol and are a crucial way of reducing risks of heart attack and stroke in people with type 2 diabetes; we estimated that by abolishing ethnic differences in statin prescribing, up to 12,600 heart attacks and strokes could be prevented in people currently affected by type 2 diabetes in the UK."
The authors conclude, "Further research must urgently seek explanations for under-prescribing of statins, particularly in African/ African Caribbean groups. If our findings are corroborated, a nationwide strategy for identifying prescribing inequities, providing targeted education, and prescribing interventions, followed by re-audit until equitability is achieved, is imperative and could lead to the prevention of substantial cardiovascular morbidity."
###
Research Article
Peer-reviewed; Observational study; Humans
In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003672
Funding: SVE is funded by a Diabetes UK Sir George Alberti Research Training Fellowship (grant number 17/0005588, https://www.diabetes.org.uk/). The funder had no role in the study design, data collection, analysis or interpretation of data, in drafting the manuscript or the decision to submit it for publication.
Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: RM reports a grant from the Wellcome Trust during the conduct of the study and personal fees from Amgen, outside the submitted work. NS has received grants and personal fees from Boehringer Ingelheim, and personal fees from Amgen, AstraZeneca, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, and Sanofi outside the submitted work. LS has received grants from the British Heart Foundation and Diabetes UK during the conduct of the study, grants from the Wellcome Trust, Medical Research Council, National Institute for Health Research, GlaxoSmithKline, British Heart Foundation, Diabetes UK, the Newton Fund and UKRI, outside the submitted work, and is a non-executive director of the MHRA. KB has received grants from the Wellcome Trust and the Royal Society during the conduct of this study. NC has received grants from Diabetes UK during the conduct of this study and personal fees from AstraZeneca outside of the submitted work. SVE has no competing interests to declare.
Citation: Eastwood SV, Mathur R, Sattar N, Smeeth L, Bhaskaran K, Chaturvedi N (2021) Ethnic differences in guideline-indicated statin initiation for people with type 2 diabetes in UK primary care, 2006-2019: A cohort study. PLoS Med 18(6): e1003672. https://doi.org/10.1371/journal.pmed.1003672
Journal
PLoS Medicine