Turk Kardiyol Dern Ars. 2010; 38(8): 544-550

Adherence to statin therapy and LDL cholesterol goal attainment in type 2 diabetics and secondary prevention patients: the role of education and knowledge

Ömer Yiğiner¹, Namık Özmen¹, Fatih Özçelik², Tuğrul İnanç³, Ejder Kardeşoğlu¹, Ömer Uz¹, Zafer Işılak¹, Mustafa Aparcı¹, İrfan Şahin⁴, Erol Arslan⁵, Bekir Sıtkı Cebeci^1
1GMMA Haydarpasa Training Hospital, Department of Cardiology, Istanbul, Turkey
²Gumussuyu Military Hospital, Biochemistry laboratory, Istanbul, Turkey
³University of Erciyes, Medical School, Departmen of Cardiology, Kayseri, Turkey
⁴Kasımpaşa Military Hospital, Department Of Cardiology, Istanbul, Turkey
⁵Balmumcu Military Outpatient Clinic, İstanbul, Turkey

OBJECTIVES
Lipid levels of most patients receiving antilipidemic therapy are not under control as proposed by the guidelines. We evaluated adherence to statin therapy and LDL cholesterol goal attainment in type 2 diabetic and secondary prevention patients.

STUDY DESIGN
A total of 194 patients (131 men, 63 women; mean age 57±11 years) who had been on statin therapy for at least a year for a target LDL cholesterol level of <100 mg/dl were administered a two-part questionnaire. The first part inquired demographic and clinical characteristics, duration of hyperlipidemia, referral to a dietician, risk factors and, if present, the reasons for drug discontinuation. The second part consisted of 23 questions (total score 30) inquiring the knowledge levels of patients about hypercholesterolemia.

RESULTS
There were 61 primary (31.4%, diabetics) and 133 secondary (68.6%) prevention patients. The mean LDL level was 122.6±28.7 mg/dl. The incidence of attaining target LDL level was only 23.7% (n=46), being lower in diabetics compared to secondary prevention patients (6.6% vs. 31.6, p<0.0001). The mean knowledge score was 18.2±5. When the threshold score was taken as 18 (median), attainment of the target LDL level was significantly higher in patients having a score of ≥18 (32%) compared to those with a lower score (14.9%). There were 77 patients (40%) who sought dietician counseling. Patients with a high school or higher education and those with dietician counseling had higher knowledge scores compared to those with a lower education level and without dietician counseling (p<0.0001). Intermittent drug discontinuation was seen in 109 patients (56.2%), the most common reason being decrease in cholesterol levels to normal (35%).

CONCLUSION
Target LDL level was achieved in only about 24%. As the knowledge on hypercholesterolemia accrues, the success rate of LDL cholesterol goal attainment increases.

Keywords: Cholesterol, LDL, diabetes mellitus, type 2; patient compliance; patient education; primary prevention; questionnaires; secondary prevention; statins

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