• Abdul Basit
  • M. Zafar Iqbal Hydrie
  • Rubina Hakeem
  • M. Yakoob Ahmedani
  • Qamar Masood


Background: During the last two decades with the introduction of statins large reductions in cholesterol concentrations were easily and safely achievable and this led to studies that demonstrated benefits of statin use. But only fewer than one fourth of adults with coronary heart disease were receiving lipid-lowering drugs in a cross sectional health survey done in England. Thus this study was designed to evaluate the frequency of statin use in type 2 Pakistani diabetic subjects with macrovascular disease attending a tertiary care unit in Karachi, Pakistan. Methods: Records of type 2 diabetic subjects coming to the outpatient department of Baqai Institute of Diabetology and Endocrinology from September 1996 to December 2001 was analyzed for their anthropometric and biochemical characteristics. Patients having any macrovascular disease were identified and frequency of statin use by these subjects was studied. Results: Out of a total of 2152 patients 502 (252 males, 250 females) having macrovascular disease were identified. Only 16.5% of them (44 males, 39 females) were taking statins. Use of statins was higher amongst those who had angina (20%) or myocardial infarction (17%) compared to those who had stroke (10%). Sixty two percent of the users while 52% of the non-users had elevated blood cholesterol. Conclusion: Frequency of statin use in the subjects studied was much lower than was warranted with respect to their disease status. Presence of elevated blood cholesterol despite using statins suggested inappropriate treatment in these subjects. Further studies are required to identify the factors leading to low use of statins in type 2 diabetic subjects with macrovascular symptoms.Keywords: Statin Users, Frequency, Lipid profile, Type 2 Diabetes, Pakistan, Macrovascular, Angina, Myocardial Infarction, Stroke.  


Garcia MJ, McNamra PM, Gordon T. Morbidity and mortality in diabetics in the Framingham population. Sixteen year follow-up study. Diabetes 1974;23:105-11.

Panzram G. Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1987:30;123-31

Stamler J, Vaccaro O, Neaton JD. for the Multiple Risk Factor Intervention Trial Research Group. Diabetes, other risk factors and 12-year cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care1993;16:434-44.

Pechacek TF, Asma S, Eriksen MP. Tobacco: global burden and community solutions. In: Yusuf S, Calms A Camm AJ, Fallen EL, Gersh BJ, eds. Evidence based cardiology. London: BMJ Books, 1998: 165-78.

Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27:335-71.

Antithrombotic Trialists Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86.

Heart Outcomes Prevention Evaluation Study Investigators. Effects of an Angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342:145-53.

Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344:1383-57.

Sacks PM, Pfeffer MA, Moye LA. The effect of Pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 336: 1001-09.

The Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastain in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 344:1383-99.

Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285: 2486-2497.

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317:703-13.

MRC/BHF Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol-lowering therapy and of antioxidant vitamin supplementation in a wide range of patients at increased risk of coronary heart disease death: early safety and efficacy experience. Eur Heart J 1999; 20:725-41.

Yusuf S. Commentary. Two decades of progress in preventing vascular disease. Lancet 2002; July 6;360:2-3.

Wood D, Durrington P, Mcinnes P. Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 1998; 80(suppl 2): S1-29.

GOD-PAP enzymatic colorimetric test. Trinder,P., Ann. Clin. Biochem., 6:24 (1969).

NGSP Steering Committee. Implementation of the National Glycohemoglobin Standardization Program (NGSP). Diabetes 46(Suppl 1), 151A. 1997.

Alberti G. A desktop guide to Type 2 diabetes mellitus. European Diabetes Policy Group 1998-1999 International Diabetes Federation European Region. Exp.Clin.Endocrinol.Diabetes 1999; 107:390-420.

European Atherosclerosis Society. Strategies for the prevention of coronary heart disease: a policy statement of the European Atherosclerosis Society. Eur Heart J 1987; 8:77-88.

NCEP. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). Jama 2001; 285:2486-2497.

World Health Organization, Regional Office for the Western Pacific, International Association for the Study of Obesity. International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne, Health Communications Australia, 2000.

NIH-NHLBI (National Institute of Health.National Heart LaBI. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 1997; National Institute of Health.National Heart,Lung,and Blood Institute. 98-4080: 11 p. NIH Publication.

Reid FDA, Cook DG, Whincup PH. Use of statins in the secondary prevention of coronary heart disease: is treatment equitable? Heart 2002; 88:15-19.

Primatesta P, Poulter NR. Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey. BMJ 2000; 321:1322-5.

Anon. Key health statistics from general practice 1998. Series M86, no 2. London: National Statistics, 2000.

Hippisley-Cox J, Pringle M, Crown N. Sex inequalities in ischaemic heart disease in general practice: cross-sectional survey. BMJ 2001; 322:832-4.

Whincup PH, Emberson JR, Lennon L. Low prevalence of lipid lowering drug use in older men with established coronary heart disease. Heart 2002; 88: 25-29.