Cardiology - Original Articles Open access

Guideline-directed statin therapy and cardiovascular events among patients with type 2 diabetes mellitus in South Ethiopia: a case-control study

Authors

Published
11 November 2026
Issue
Early Access
Section
Cardiology - Original Articles
DOI
10.4081/monaldi.2026.4262

Abstract

Type 2 diabetes mellitus (T2DM) significantly increases cardiovascular disease (CVD) risk. Statin therapy is a cornerstone of primary prevention, yet suboptimal prescribing and adherence remain common, particularly in resource-limited settings. Evidence on statin utilization and outcomes in Ethiopian T2DM patients is limited. This study aimed to determine the association between guideline-directed statin therapy and cardiovascular events among T2DM patients at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH).

A hospital-based case-control study was conducted from April to July 2022 at WSUCSH in South Ethiopia. Cases were T2DM patients aged 40-75 years who developed a first cardiovascular event after T2DM diagnosis. Controls were T2DM patients without CVD, frequency-matched by age (±5 years) and sex. Data were collected through retrospective medical record review and patient interviews using a structured data abstraction form and the Morisky Medication Adherence Scale. Unconditional logistic regression was used to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CI), with age and sex included as covariates to account for the frequency-matched design. A p-value <0.05 was considered statistically significant.

A total of 196 participants (98 cases and 98 controls) were included. Among cases, stroke (43.9%) and myocardial infarction (35.7%) were the most frequent cardiovascular events. Patients receiving guideline-directed statin therapy had significantly lower odds of CVD events [AOR=0.242, 95% CI: 0.093-0.630, p=0.004]. However, only 13.8% received guideline-concordant therapy, and annual lipid testing was documented in only 4.6%.

In this case-control study, guideline-directed statin therapy was associated with lower odds of cardiovascular events among T2DM patients in South Ethiopia. However, the majority of participants did not receive guideline-concordant therapy, highlighting a substantial practice gap. Interventions to improve statin prescribing, adherence, and continuity are urgently needed in this setting.

Keywords

Ethics Approval

The study received approval from the Institutional Review Board (IRB) of Wolaita Sodo University, College of Health Sciences (IRB No: CRCSD/ERC/098/02/14).

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