Statin eligibility based on the ACC/AHA guidelines among Middle Eastern patients with diabetes mellitus presenting with acute myocardial infarction

Mohamad I Jarrah; Muhannad J Ababneh; Loai Issa Tawalbeh; Ayman J Hammoudeh; Hanan M Barukba; Ahmad Othman

doi:10.1016/j.amsu.2020.12.036

Statin eligibility based on the ACC/AHA guidelines among Middle Eastern patients with diabetes mellitus presenting with acute myocardial infarction

Ann Med Surg (Lond). 2020 Dec 29:61:148-154. doi: 10.1016/j.amsu.2020.12.036. eCollection 2021 Jan.

Authors

Mohamad I Jarrah¹, Muhannad J Ababneh¹, Loai Issa Tawalbeh², Ayman J Hammoudeh³, Hanan M Barukba¹, Ahmad Othman¹

Affiliations

¹ Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
² Faculty of Nursing, Al al-Bayt University Al-Mafraq, P.O. Box: 130049, 25113, Jordan.
³ Department of Cardiology, and Coronary Computed Tomography Section, Istishari Hospital, Amman, Jordan.

Abstract

Background: Statin eligibility based on the American College of Cardiology/American Heart Association cholesterol guidelines among patients with diabetes admitted with first time acute myocardial infarction has not been evaluated in the Middle East.

Purpose: To assess statin eligibility for diabetic patients admitted with first time myocardial infarction in Jordan according to ACC/AHA guidelines.

Methods: Consecutive patients admitted with a first acute myocardial infarction who were not taking statins, and had their serum lipoproteins measured upon hospital admission were enrolled in the study. Statin eligibility among patients with diabetes admitted with first time myocardial infarction was determined based on the ACC/AHA guidelines.

Results: Of 774 patients enrolled, 292 (37.30%) had diabetes. Compared with non-diabetic patients, those with diabetes were females, older, more hypertension, more hypercholesterolemia, more triglycerides, more diastolic blood pressure, less smokers and less low density lipoprotein. Among patients with diabetes, 242 diabetic patients (82.9%) were statin eligible, including 20 (6.90%) for having high serum levels of low density lipoprotein cholesterol (LDL-C) >190 mg/dL, and 222 (76%) for being aged 40-75 years with LDL-C 70-189 mg/dL. No patient had a calculated atherosclerotic cardiovascular risk score ≥7.5%. On the other hand, 393 non-diabetic patients (81.3%) were statin eligible, including 41 (8.50%) for having high serum levels of low density lipoprotein cholesterol (LDL-C) >190 mg/dL, and 351 (72.80%) for being aged 40-75 years with LDL-C 70-189 mg/dL.

Conclusions: Based on the ACC/AHA guidelines, the majority of patients with diabetes admitted with first acute myocardial infarction would have been eligible for statin treatment if they have LDL-c >190 mg/dl or aged 40-75 years old and they have their LDL 70-189 mg/gl. More efforts should be taken for patients who are female, older than 50 years, hypertensive, elevated diastolic blood pressure have hypercholesterolemia, and elevated triglycerides because of their significant association with diabetes.

Keywords: ACC/AHA; Diabetes mellitus; Middle east; Statin eligibility.