LDL-cholesterol trajectories and statin treatment in Finnish type 2 diabetes patients: a growth mixture model

• Published in: Scientific Reports
• Main Authors: Inglin, Laura, Lavikainen, Piia, Jalkanen, Kari, Laatikainen, Tiina
• Other Authors: Strategic Research Council of the Academy of Finland, Diabetesliitto, Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding
• Format: Article in Journal/Newspaper
• Language: English
• Published: Springer Science and Business Media LLC 2021
• Subjects: Multidisciplinary; karelia*
• Online Access: http://dx.doi.org/10.1038/s41598-021-02077-6; https://www.nature.com/articles/s41598-021-02077-6.pdf; https://www.nature.com/articles/s41598-021-02077-6

Abstract We aimed to identify distinct longitudinal trends of LDL-cholesterol (LDL-C) levels and investigate these trajectories’ association with statin treatment. This retrospective cohort study used electronic health records from 8592 type 2 diabetes patients in North Karelia, Finland, comprising all primary and specialised care visits 2011‒2017. We compared LDL-C trajectory groups assessing LDL-C treatment target achievement and changes in statin treatment intensity. Using a growth mixture model, we identified four LDL-C trajectory groups. The majority (85.9%) had “moderate-stable” LDL-C levels around 2.3 mmol/L. The second-largest group (7.7%) consisted of predominantly untreated patients with alarmingly “high-stable” LDL-C levels around 3.9 mmol/L. The “decreasing” group (3.8%) was characterised by large improvements in initially very high LDL-C levels, along with the highest statin treatment intensification rates, while among patients with “increasing” LDL-C (2.5%), statin treatment declined drastically. In all the trajectory groups, women had significantly higher average LDL-C levels and received less frequent any statin treatment and high-intensity treatment than men. Overall, 41.9% of patients had no statin prescribed at the end of follow-up. Efforts to control LDL-C should be increased—especially in patients with continuously elevated levels—by initiating and intensifying statin treatment earlier and re-initiating the treatment after discontinuation if possible.