Association between age and the initiation of antihypertensive, lipid lowering and antiplateletet medications in elderly individuals newly treated with antidiabetic drugs

Research Letters Association between age and the initiation of antihypertensive, lipid lowering and antiplateletet medications in elderly individuals newly treated with antidiabetic drugs SIR—The elderly are the age group most affected by diabetes mellitus [1]. Given that the general population is age-ing, the number of older individuals with diabetes is likely to increase. Moreover, diabetes is often accompanied by several co-morbidities [2], not to mention cardiovascular disease (CVD), the main complication of diabetes [3]. Antihypertensive [4], lipid-lowering [5] and antiplatelet [6] drugs are known to decrease cardiovascular complications in diabetes. Even though there is little evidence from clinical trials in elderly patients with diabetes, most older patients with this condition require pharmacological treatments in order to reach the clinical targets recommended in guidelines [7–9]. The Canadian Diabetes Association recommends the same targets for older patients than for younger ones (130/ 80 mmHg; LDL-cholesterol 2.6 mmol/l), although more conservative objectives are suggested for individuals with multiple co-morbidities [7]. Similar recommendations are found in guidelines from other associations [8, 9]. In many instances, there is evidence that quality of treatment diminishes with increasing age [10–14]. In a study of 6,626 prevalent users of antidiabetic drugs, the older the individuals were, the less likely they were to use a statin or an angiotensin converting enzyme (ACE) inhibitors [10]. However , since patients could have been using cardiovascular protective treatments before they started oral antidiabetic drugs, the question remains as to whether or not age affects initiation of cardioprotective treatments among individuals with diabetes. The objective of this study was to assess the association between age and the initiation of antihypertensive, lipid-lowering and antiplatelet drugs during the year following commencement of an oral antidiabetic drug among individuals aged 66 years and over. Methods We performed a population-based cohort study using the Quebec Diabetes Surveillance Database (QDSD). The database results from the linking of five public health administrative databases. For individuals who had been diagnosed with diabetes, it includes information on patient demograph-ics, physician and hospital services and data from the public drug plan. From the QDSD, individuals aged ≥66 years were selected if they had initiated an oral antidiabetic drug between 1 January 1998 and 31 December 2002. The date of the first claim formed the index date. We excluded all individuals who (1) had a claim for insulin or any oral antidiabetic drug in the year before the index date, (2) had not …