Products & Programs PharmacyMedicare AdvantageJune 1, 2024

Improving patient outcomes with statin therapy in diabetes

Cardiovascular disease is the leading cause of death among people with diabetes. 1 National guidelines continue to recommend statin therapy in all patients with diabetes between the ages of 40 and 75, regardless of low-density lipoprotein (LDL) level, to prevent development of cardiovascular disease:

  • Reducing LDL-C levels by ~39 mg/dL with statin therapy can reduce heart disease and stroke mortality by 13%, regardless of the baseline LDL cholesterol levels.1
  • Nearly 60% of statin-eligible patients were never offered statin therapy by their doctor.2 Moreover, 50% of adults in the United States who would benefit from statins are taking them.3
  • Up to 34% of patients never fill the initial statin prescription (primary non-adherence).4

Statin Use in Patients with Diabetes (SUPD) is a CMS-adopted quality Star measure:

  • The SUPD measure is defined as percent of Medicare Part D beneficiaries 40 to 75 years old who were dispensed at least two diabetes medication fills and received a statin medication fill during the measurement period.
  • When assessing patients for appropriateness of statin therapy, also evaluate for potential measure exclusions.

Exclusions for the SUPD measure include:

  • End stage renal disease.
  • Hospice.
  • Rhabdomyolysis or myopathy.
  • Pregnancy/lactation.
  • Cirrhosis.
  • Pre-diabetes.
  • Polycystic ovary syndrome.
  • Fertility medication.

    • Reassess patient every year to evaluate the appropriateness of acceptable exclusions.
    • Exclusions require a submitted code each calendar year.

Best practices in initiating and improving statin adherence:

  • Offer statin therapy to all patients ages 40 to 75 years old who have diabetes, regardless of LDL.
  • Guidelines recommend moderate or high intensity statin depending on additional risks.
  • Get patient buy-in: Ask patients what they know about statins. Address any fears or concerns and educate them on statin benefits:
    • Fear of and perceived side effects are the most common reasons for declining or discontinuing statin therapy.4
  • Once a statin has been prescribed, follow up with patients to assess adherence.
  • Be aware of best practices to evaluate patient reported muscle side effects and an implementation strategy for re-initiation.

View a video about statins here.

References:

  1. American Diabetes Association Professional Practice Committee. 10. Cardiovascular disease and risk management: Standards of Care in Diabetes—2024. Diabetes Care 2024;47(Suppl. 1):S179–S218
  2. Bradley CK, Wang TY, Li S, et al. Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry. Journal of the American Heart Association. 2019;8(7). doi: https://doi.org/10.1161/jaha.118.011765
  3. Wall HK, Ritchey MD, Gillespie C, Omura JD, Jamal A, George MG. Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 — United States, 2011–2016. MMWR Morb Mortal Wkly Rep 2018;67:983–991. DOI: http://dx.doi.org/10.15585/mmwr.mm6735a4
  4. 2 Tarn DM, Barrientos M, Pletcher MJ, et al. Perceptions of Patients with Primary Nonadherence to Statin Medications. The Journal of the American Board of Family Medicine. 2021;34(1):123-131. doi: https://doi.org/10.3122/jabfm.2021.01.200262
  5. CDC. Statins and Diabetes: What You Should Know. Centers for Disease Control and Prevention. Published January 30, 2023. cdc.gov/diabetes/library/features/Statins_Diabetes.html
  6. Kearney PM, Blackwell L, Collins R, et al.; Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371:117–125
  7. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140(11). doi: https://doi.org/10.1161/cir.0000000000000678
  8. Collins R, Reith C, Emberson J, et al. The Lancet. 2016;388(10059):2532-2561. Interpretation of the evidence for the efficacy and safety of statin therapy. doi: https://doi.org/10.1016/s0140-6736(16)31357-5
  9. Hla D, Jones R, Blumenthal RS, et al. Assessing severity of statin side effects: Fact vs fiction. American College of Cardiology. April 09, 2018. Accessed May 17, 2023. acc.org/latest-in-cardiology/articles/2018/04/09/13/25/assessing-severity-of-statin-side-effects
  10. Reston JT, Buelt A, Donahue MP, Neubauer B, Vagichev E, McShea K. Interventions to Improve Statin Tolerance and Adherence in Patients at Risk for Cardiovascular Disease. Annals of Internal Medicine. 2020;173(10):806-812. doi: https://doi.org/10.7326/m20-4680

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PUBLICATIONS: June 2024 Provider Newsletter