Prevalence, treatment rates and control of dyslipidemia among diabetes patients in northern Nigeria: A cross-sectional, multicenter study

Abstract

Abstract Objectives Dyslipidemia is prevalent among Nigerians living with diabetes, but the rate and extent of treatment have not been well-studied. The objective of this study was to determine the prevalence, treatment rates and control of dyslipidemia among diabetes patients in northern Nigeria. Methods We conducted a multicenter, cross-sectional study of diabetes clinic patients. We noted cardiovascular risk factors, lipid-lowering treatments and examination findings, including body mass index, blood pressure, glycated hemoglobin, lipid profile, glomerular filtration rate and urinalysis. Outcome measures were the rate of dyslipidemia, the proportion of patients treated for dyslipidemia, and the proportion of patients with low density lipoprotein cholesterol goal and target for primary prevention of cardiovascular disease. Results The study enrolled 403 participants (58.8% females), of whom 59.6% had dyslipidemia. Female gender and proteinuria were independently associated with dyslipidemia, with odds ratios of 1.74 and 2.26, respectively. Other cardiovascular risk factors of participants were hypertension (56.8%), obesity (52.6%), chronic kidney disease (36.5%), atrial fibrillation (7.9%), heart failure (5.0%), cigarette smoking (4.7%), excess alcohol use (2.0%), and previous cardiovascular disease (14.4%). In those with dyslipidemia, 51.3% took lipid-lowering treatments comprising statins (49.6%), clofibrate (1.7%) and statins combined with clofibrate (1.2%). None took other lipid-lowering treatments beside dietary control, probably due to high costs compared to statins. Only 17.1% of all participants attained the target for primary prevention of cardiovascular disease in people with diabetes. Conclusion Most patients had dyslipidemia, which was more prevalent in females. Only a sixth of all patients had attained the treatment target. Treatment for dyslipidemia was limited to statins and fibrates, contrary to guideline recommendations for the use of ezetimibe, bempedoic acid, icosapent ethyl, or PCSK9 inhibitors for those who failed intensive statin therapy. There is a need for physician adherence to practice guidelines for the treatment of dyslipidemia, and improved access to treatment in northern Nigeria.