Statin utilization patterns for the primary prevention of cardiovascular events: a retrospective study in patients with diabetes mellitus in Hong Kong.

BACKGROUND AND OBJECTIVE: In Hong Kong, about 10% of adults 25-74 years of age have diabetes mellitus. The management of dyslipidemia with lipid-lowering agents (LLAs), including HMG-CoA reductase inhibitors (statins) for the primary prevention of cardiovascular complications, has been found to be beneficial. This study examined statin utilization patterns for the primary prevention of cardiovascular events in patients with diabetes mellitus in two public hospitals in Kong Kong; clinical outcomes in patients who received statins for primary prevention were compared with those in patients not treated with any LLAs. METHODS: This was a retrospective study in patients who were diagnosed with diabetes mellitus. Only patients with no prior history of coronary artery disease were included in the study. Utilization patterns of LLAs and the incidences of cardiovascular complications were recorded from 1 January 2002 to 31 December 2003. RESULTS: A total of 222 patient records were reviewed. Only 75/222 (33.8%) of patients with diabetes mellitus received one or more LLAs for the primary prevention of cardiovascular events. Among these patients, only 21% of patients attained target lipid goals. Nearly half of the patients who were not treated with LLAs (n=147) had dyslipidemia problems. The overall incidence of cardiovascular complications in patients treated and not treated with LLAs was 12.2%. Absence of routine screening for cardiovascular risk and sub-optimal utilization and inadequate dosage titration of LLAs were identified as contributory factors towards cardiovascular events in this patient group. CONCLUSION: The current study failed to prove the benefits of LLAs in reducing the risk of first cardiovascular events in diabetic patients. This may have been due to the use of low doses of LLAs and a lack of laboratory monitoring of cholesterol levels. Development and implementation of guidelines may help promote the use of LLAs in primary prevention of cardiovascular complications.

Current evidence on dietary pattern and cognitive function.

With global aging population, age-related cognitive decline becomes epidemic. Lifestyle-related factor is one of the key preventative measures. Dietary pattern analysis which considers dietary complexity has recently used to examine the linkage between nutrition and cognitive function. A priori approach defines dietary pattern based on existing knowledge. Results of several dietary pattern scores were summarized. The heterogeneity of assessment methods and outcome measurements lead to inconsistent results. Posteriori approach derives a dietary pattern independently of the existing nutrition-disease knowledge. It showed a dietary pattern abundant with plant-based food, oily fish, lower consumption of processed food, saturated fat, and simple sugar which appears to be beneficial to cognitive health. Despite inconclusive evidence from both approaches, diet and exercise, beneficial for other diseases, remains to be the two key modifiable factors for cognitive function. Large-scale prospective studies in multiethics population are required to provide stronger evidence in the future.