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. 2024 Jun 20;23:100297. doi: 10.1016/j.metop.2024.100297

Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients in Africa: A systematic review and meta-analysis

Worku Chekol Tassew a,⁎, Yeshiwas Ayale Ferede b, Agerie Mengistie Zeleke c
PMCID: PMC11246013  PMID: 39006881

Abstract

Background

In sub-Saharan African nations, there's a documented shortfall in the utilization of statins, despite established clinical guidelines advocating their use for reducing cardiovascular risks and overall mortality among Type 2 diabetes patients aged 40–75 years old. Most clinical guidelines recommend prescribing statins to individuals with type 2 diabetes to reduce the chances of cardiovascular disease. There is currently a lack of extensive research on statin utilization specifically for primary prevention of cardiovascular disease in Africa. Thus, this study aimed to assess the prescription patterns of statins for preventing cardiovascular disease in type 2 diabetes patients.

Methods

The findings of the review were presented following the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-2020) checklist. We conducted searches on electronic databases including PubMed, EMBASE, Cochrane Library, Science Direct, African Journal Online, and Google Scholar. This systematic review and meta-analysis included articles that met specific inclusion criteria: observational studies such as cross-sectional, cohort, and case-control studies focusing on determinants, risk factors, or correlates associated with statin prescription within Africa. Only published articles up to June 2, 2024, published in English, and conducted in either community or healthcare facility settings were considered. Data import was initially conducted using Microsoft Excel, and statistical analysis was performed using STATA software. Cochran's Q test was employed to assess whether there was a significant variance in prevalence among the studies. Additionally, the I2 statistic was utilized to quantify the extent of heterogeneity. A funnel plot, a visual tool, was utilized to evaluate publication bias.

Results

The search strategy resulted in 7695 published original articles. The full texts of the 89 papers were assessed for eligibility and quality. Moreover, some articles were rejected due to inaccuracies in the outcome variable. Ultimately, only ten studies focusing on the prevalence of statin prescription were examined. The research suggests that the pooled prevalence of statin prescription among Type 2 diabetic individuals in Africa is found to be 48.82% (95% CI: 35.41–63.24). Age greater than 65 years (AOR = 3.56, 95% CI: 1.70–7.45; I2 = 54.7%), comorbidity (AOR = 1.13, 95% CI: 0.27–4.63, I2 = 96.4%), dyslipidemia (AOR = 3.15, 95% CI: 1.54–6.44, I2 = 61.7%), DM duration greater than ten years (AOR = 1.36, 95% CI: 0.81–2.28, I2 = 77.3%), and government insurance (AOR = 8.85, 95% CI: 2.72–28.76, I2 = 81.5%) were factors associated with statin prescription among type 2 diabetic patients.

Conclusions

In general, the extent of statin prescriptions for individuals with type 2 diabetes who are eligible for statin therapy was below the target outlined by clinical practice guidelines. Being over 65 years old, having comorbidities, experiencing dyslipidemia, having type 2 diabetes for more than ten years, and having government insurance were all identified as independent factors predicting the prescription of statins. This finding is concerning and underscores the urgent need to enhance adherence to clinical practice guidelines for the well-being of this vulnerable population at high risk.

Keywords: Statin prescription, Associated factors, Systematic review, Africa

1. Background

Cardiovascular disease (CVD), encompassing coronary artery disease (CAD), stroke (CVA), and peripheral arterial disease (PAD), is a major complication of type 2 diabetes mellitus (T2DM) and is responsible for the majority of morbidity and deaths among individuals with type 2 diabetes mellitus [1]. Type 2 diabetes and unhealthy lipid levels go hand-in-hand, significantly increasing the risk of CVD for these individuals [2]. According to the American Heart Association, approximately 65% of individuals diagnosed with diabetes pass away due to some manifestation of cardiovascular disease. Lipid-lowering statin therapy is a cornerstone for preventing atherosclerotic cardiovascular disease (ASCVD) in diabetic patients. By lowering LDL cholesterol (“bad" cholesterol) levels, statins help prevent the initial buildup of plaque in arteries, thereby reducing the risk of future ASCVD events like heart attack or stroke. For diabetic patients already diagnosed with ASCVD, statins play a crucial role in slowing the progression of existing plaque buildup and reducing the risk of future cardiovascular events. Statins provide various advantages beyond simply reducing LDL cholesterol levels. These additional effects, often referred to as pleiotropic effects, contribute to their overall effectiveness in reducing the risk of cardiovascular disease in diabetic patients. These effects are broader cardiovascular effects, such as stabilizing atherosclerotic plaques, reducing inflammation, inhibiting the proliferation of vascular smooth muscle cells, suppressing platelet function, and enhancing vascular endothelial function [[3], [4], [5]].

Extensive research supports the use of statins for reducing cardiovascular disease risk in individuals with diabetes, particularly those with a high risk of CVD. Statin use can lead to a significant reduction in all-cause mortality in high-risk individuals [6]. The 2019 guideline by the American College of Cardiology/American Heart Association (ACC/AHA) did indeed endorse primary statin treatment for averting cardiovascular disease among individuals at heightened risk [7]. The Collaborative Atorvastatin Diabetes Study (CARDS) stands as a pivotal research endeavor that fortifies the utilization of statins for the primary prevention of cardiovascular disease among diabetic individuals. Numerous studies and meta-analyses provide evidence supporting the efficacy of statins in mitigating risk factors associated with cardiovascular disease among diabetic patients [8,9].

Numerous clinical trials have convincingly demonstrated the benefits of statin therapy in improving CVD outcomes for a wide range of patients [10]. According to a meta-analysis study done on statin medication, for every 1 mmol/l (39 mg/dl) decrease in low-density lipoprotein (LDL) cholesterol levels, there was a 9% decrease in overall mortality and a 13% decrease in vascular mortality [11]. Statins are the preferred drugs for lowering LDL cholesterol and providing heart protection. Clinical practice recommends two intensities of statin dosing: moderate and high. Moderate-intensity statin therapy involves medications like atorvastatin (10–20 mg), rosuvastatin (5–10 mg), Simvastatin (20–40 mg), pravastatin (40–80 mg), lovastatin (40 mg), fuvastatin (40 mg twice daily or 80 mg once daily), and pitavastatin (2–4 mg). High-intensity statin therapy utilizes atorvastatin (40–80 mg) and rosuvastatin (20–40 mg). Moderate-intensity statins typically reduce LDL cholesterol by 30%–50%, while high-intensity therapy lowers LDL cholesterol by around 50% [12,13].

The 2021 American Diabetes Association standards of medical care in diabetes advise high-intensity statin therapy alongside lifestyle changes for all diabetes patients with ASCVD. For those aged 40–75 without ASCVD, a high-intensity statin is recommended, while those over 75 without ASCVD should use a moderate-intensity statin. Patients under 40 with additional ASCVD risk factors should consider moderate-intensity statins. Individual responses and tolerances should guide statin intensity adjustments, with the maximally tolerated dose preferred. For diabetes patients aged 40 and above with multiple cardiovascular risk factors but no evident ASCVD, high-intensity statins are suggested [14,15]. Statins are demonstrably effective in reducing CVD risk, yet there's a concerning gap between guidelines and real-world practice regarding their use for primary prevention [16]. In sub-Saharan African nations, there's a documented shortfall in the utilization of statins, despite established clinical guidelines advocating their use for reducing cardiovascular risks and overall mortality among Type 2 diabetes patients aged 40–75 years old [17,18].

Most clinical guidelines recommend prescribing statins to individuals with Type 2 Diabetes to reduce the chances of cardiovascular disease. There is currently a lack of extensive research on statin utilization specifically for primary prevention of CVD in Africa. Thus, this study aimed to assess the prescription patterns of statins for preventing CVD in Type 2 diabetes patients. By offering contemporary data on statin prescription rates for T2D patients in CVD prevention, this research seeks to contribute to existing scientific literature.

2. Materials and methods

2.1. Protocol design and registration

The review protocol has been registered in prospective register of systematic reviews (PROSPERO) with the reference number of CRD42024553828. The findings of the review were presented following the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-2020) checklist [19] (SF1).

2.2. Eligibility criteria

This systematic review and meta-analysis included articles that met specific inclusion criteria: observational studies such as cross-sectional, cohort, and case-control studies focusing on determinants, risk factors, or correlates associated with statin prescription within Africa. Only published articles up to June 2, 2024, published in English, and conducted in either community or healthcare facility settings were considered.

2.3. Data sources and searching strategy

We conducted searches on electronic databases including PubMed, EMBASE, Cochrane Library, Science Direct, African Journal Online, and Google Scholar. Endnote (version 7) reference management software facilitated the organization, review, citation, and removal of duplicate articles. Controlled vocabulary (MeSH) terms were utilized for search strategies. Synonyms for “statin" were identified, and search strings were formulated across the databases. Articles were searched by title, abstract, and/or full text, employing Boolean logic operators “AND" and “OR" to combine search terms. The search string included terms such as “statin*", “lipid lowering drugs", “HMG-CoA reductase inhibitors", “cholesterol lowering drugs", in combination with terms related to diabetes mellitus (Type 1 and Type 2), hyperglycemia, or elevated blood glucose, all within the context of Africa. This search encompassed articles published up to June 2, 2024. Snow ball technique from retrieved articles also used to add additional articles.

2.4. Study selection

Articles identified through the search process were imported into EndNote software version X7 (Thomson Reuters, New York, NY), where duplicate entries were removed. Subsequently, two independent authors (WCT and YAM) assessed the titles of the remaining articles and excluded any ineligible papers. Prior to data extraction, the full texts of the selected publications were obtained and meticulously reviewed to confirm their eligibility. Only articles meeting the inclusion criteria were included in the analysis.

2.5. Data extraction and quality assessment

Two authors, WCT and YAF, independently conducted reviews of abstracts and full texts, as well as data extraction, using a standardized data abstraction form created in MS Excel. This form was designed to capture the necessary information from primary studies in a structured manner. The extracted data encompassed the primary author's name, publication year, study setting/country, study design, response rate, sample size, sampling technique, and magnitude of statin prescription. The quality assessment of the included studies was performed by two assessors, WCT and AMZ, utilizing the Johanna Briggs Institute (JBI) quality evaluation checklist [20]. The components of the JBI quality assessment checklist include the following nine items.

  • 1.

    Pattern body (design): This ensures the research design is appropriate for the question being asked and the population studied.

  • 2.

    Sample: This assesses if the study participants were chosen in a way that represents the target population and minimizes bias in who was included.

  • 3.

    Sample size: This evaluates whether there were enough participants to ensure the study results are statistically reliable and can be generalized to a larger population.

  • 4.

    Concepts: This ensures the key concepts being investigated are clearly defined and understood throughout the study.

  • 5.

    Record evaluation: This assesses the reliability and consistency of the methods used to collect data from participants, such as surveys or interviews.

  • 6.

    Identification of the condition: This evaluates if the study used valid methods to diagnose the condition of interest.

  • 7.

    Measurement: This ensures consistent measurement tools were used across all participants to assess relevant variables.

  • 8.

    Statistical analysis: This assesses if appropriate statistical methods were used to analyze the data and draw conclusions based on the research question and study design.

  • 9.

    Response rate: This evaluates if a sufficiently high proportion of participants completed the study to ensure the findings are reliable and not skewed by dropouts.

The total score (0–9) then provides an overall assessment of the study's methodological quality, categorized as low (0–4), medium [5,6], or high [[7], [8], [9]].

2.6. Outcome measurement

This review primarily aimed to ascertain the pooled prevalence of statin prescriptions in Africa. Statin users were defined as individuals receiving preventive therapy with statins when initiated on a standard dose of the medication due to indications outlined in the 2019 American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations [21].

2.7. Statistical analysis

2.7.1. Testing for heterogeneity

Data import was initially conducted using Microsoft Excel, and statistical analysis was performed using STATA software. Cochran's Q test was employed to assess whether there was a significant variance in prevalence among the studies. Additionally, the I2 statistic was utilized to quantify the extent of heterogeneity. A p-value below 0.05 was considered statistically significant, suggesting that the observed variability was unlikely to be attributable to chance [22]. Variability was categorized as low (I2 < 25%), moderate (25% ≤ I2 ≤ 75%), or high (I2 > 75%) [23,24]. Since there was expected variability among the included studies, a random-effects model was utilized to estimate the effect of the pooled prevalence of statin usage [25]. A forest plot was employed to illustrate the pooled effect size alongside the corresponding odds ratio and its 95% confidence interval. Subgroup analysis was conducted by categorizing studies based on their sampling procedures to compare prevalence estimates within each subgroup. Additionally, sensitivity analysis was carried out to evaluate the influence of individual studies that might have significantly affected the overall estimate.

2.7.2. Assessment of publication bias

A funnel plot, a visual tool, was utilized to evaluate publication bias. Egger's test was also employed for this purpose. A p-value below 0.05 from Egger's test indicated significant publication bias, suggesting that studies with larger effects (either positive or negative) are more likely to be published, indicating potential bias in publication selection [26].

3. Results

3.1. Study selection

Fig. 1 shows the flow chart and selection method for determining the pooled prevalence of statin prescriptions among type 2 diabetic patients. The search strategy resulted in 7695 published original articles. These comprised 14 from PubMed, 6 from Science Direct, 7390 from Google Scholar, 232 from EMBASE, 2 from the Cochrane Library, and 51 from the African Journal Online. About 4325 duplicate articles were eliminated, and an extra 2981 publications were disregarded due to their lack of relevance to the research topic. Additionally, 300 articles were excluded as they did not involve the study population. The full texts of the 89 papers were assessed for eligibility and quality. Moreover, some articles were rejected due to inaccuracies in the outcome variable. Ultimately, only ten studies focusing on the prevalence of statin prescription were examined (Fig. 1).

Fig. 1.

Fig. 1

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PRISMA flow diagram for the systematic review and meta-analysis of Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients in Africa (n = 10).

3.2. Overview of included studies

The recent research comprised 10 primary papers published until 2024, involving a combined sample size of 4350 individuals. Six articles were obtained from Ethiopia [[27], [28], [29], [30], [31], [32]], two were from Ghana [33,34] and the remaining were from Botswana and Tanzania [35,36]. All of the inquiries were published in peer-reviewed academic journals. The oldest study was published in 2018, with the most recent one appearing in 2024. The studies analyzed had participant counts spanning from 145 to 1427 individuals. Among them, eight studies employed an institutional-based cross-sectional study design. Statin prescription prevalence ranged from 16.8% to 85.4%, with the highest and lowest figures observed respectively (Table 1).

Table 1.

Overview of included studies in the systematic review and meta-analysis of the prevalence of satin prescription in Africa (n = 10).

Author name Pub year Country Sampling technique Sample size Prevalence Quality Score
Melaku et al. [27] 2018 Ethiopia simple random 150 36.67 High
Kebede zelalem and Feyisa [28] 2020 Ethiopia consecutive sampling 145 42.5 High
Fisseha et al. [29] 2024 Ethiopia systematic random 422 85.4 High
Demoz et al. [30] 2019 Ethiopia systematic random 323 55.7 High
Nigussie and Demeke [31] 2023 Ethiopia consecutive sampling 423 61.2 High
Bideberi and Mutagaywa [35] 2022 Tanzania Convenience 400 47.3 High
Melaku et al. [32] 2023 Ethiopia consecutive sampling 389 42.93 High
Mwita et al. [36] 2020 Botswana simple random 500 45.5 High
Brobbey et al. [33] 2020 Ghana purposive sampling 171 49.5 Medium
Sarfo and Ovbiagele [34] 2020 Ghana simple random 1427 16.8 High
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3.3. Quality appraisal

The JBI quality assessment criteria tailored for analytical cross-sectional studies were applied (SF2).

3.4. Meta-analysis

3.4.1. Pooled estimates of statin prescriptions

The research suggests that the pooled prevalence of statin prescription among Type 2 diabetic individuals in Africa is found to be 48.82% (95% CI: 35.41–63.24), with an I2 statistic of 92.0%, indicating considerable heterogeneity among the included studies. Given this high level of heterogeneity, a random-effect model was employed to calculate the pooled prevalence of statin prescriptions (Fig. 2).

Fig. 2.

Fig. 2

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Forest plot for the prevalence of statin prescription among type 2 diabetic patients in Africa (n = 10).

3.4.2. Subgroup analysis

The subgroup analysis indicated that studies employing non-probability sampling methods had the highest pooled prevalence of statin prescriptions, reaching 49.46% (Fig. 3).

Fig. 3.

Fig. 3

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A subgroup analysis of the forest plot showing the pooled prevalence of statin prescription among type 2 diabetic patients in Africa based on the sampling procedure.

3.4.3. Publication bias

The funnel plot indicated a balanced spread of studies, indicating no apparent publication bias. Egger's test further supported this finding, with a statistically significant p-value of 0.182 at the 5% significance level, confirming the absence of bias (Fig. 4).

Fig. 4.

Fig. 4

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Funnel plot showing publication bias.

3.4.4. Sensitivity analysis

The subgroup analysis showed significant variability among the studies. We performed a sensitivity analysis to assess how each study influenced the overall results. No individual primary study has explored the overall prevalence of statin prescription among Type 2 diabetic patients across Africa.

3.4.5. Factors associated with statin prescription

The results suggest age showed a statistically significant association with statin prescriptions, in that patients aged greater than 65 years were three times (AOR = 3.56, 95% CI: 1.70–7.45; I2 = 54.7%) more likely to prescribe statin than those <64 years old. Similarly, statin prescriptions were 1.13 times more likely for participants who had comorbidity than participants who did not have comorbidity (AOR = 1.13, 95% CI: 0.27–4.63, I2 = 96.4%). Participants with dyslipidemia were 3.15 times as likely to be prescribed statins as their counterparts without dyslipidemia (AOR = 3.15, 95% CI: 1.54–6.44, I2 = 61.7%). Statins were 1.36 times more likely to be prescribed for participants with DM duration greater than ten years than participants with DM duration less than 10 years old (AOR = 1.36, 95% CI: 0.81–2.28, I2 = 77.3%). Participants with government insurance were 8.85 times more likely to be prescribed statins than their counterparts without insurance (AOR = 8.85, 95% CI: 2.72–28.76, I2 = 81.5%) (Fig. 5).

Fig. 5.

Fig. 5

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Factors associated with statin prescription among type 2 DM in Africa.

4. Discussion

Diabetes mellitus has now reached pandemic proportions, showing an alarming increase in both illness rates and fatalities. Managing type 2 diabetes revolves around regulating blood sugar levels and preventing complications. In recent decades, integrated healthcare systems have evolved significantly, altering the delivery of diabetes care and the treatment of associated conditions. Given that high cholesterol is a leading risk factor for coronary heart disease (CHD), a critical strategy for reducing CVD risk, both in primary and secondary prevention, involves lowering LDL-C levels. Numerous clinical trials have also suggested that certain subsets of patients treated with statins may benefit from more aggressive lipid-lowering therapy. The objective of this study was to present recent data on the usage of statin prescriptions for primary prevention of CVD among individuals with type 2 diabetes in Africa.

The prescription pattern conducted in this study reveals that statins are prescribed to 48.82% (with a 95% confidence interval ranging from 35.41% to 63.24%) of patients diagnosed with type 2 diabetes. The current findings align with previous studies conducted in India, where statin prescription rates were at 55.2% [37], in Denmark at 47% [38], and in the USA at 40% [39]. Nevertheless, the proportion observed in this study is higher compared to findings from research conducted in Germany (25.0%) [40], the United Kingdom (33.0%) [41], Malaysia (35.1%) [42], Hong Kong (33.3%) [43], and Saudi Arabia (27.2%) [44]. Divergence in adherence to prescribed guidelines could potentially account for such variations. Furthermore, the finding of the study is lower than a report from USA 68.3% [45], Malaysia, 65% [46] and Denver, reported where 100% were prescribed an appropriate intensity of statins [47]. The low rate of prescriptions may stem from several factors: firstly, the absence of local protocols; secondly; insufficient compliance with existing global standards, and thirdly, restricted availability of medications and lipid tests owing to socioeconomic challenges.

The results suggest age showed a statistically significant association with statin prescriptions; in that patients aged greater than 65 years were three times more likely to prescribe statin than those <64 years old. Similar findings have been reported in the United States [48] and Europe [49]. The rise in statin utilization with age is typically justified since cardiovascular risk tends to escalate with advancing age, resulting in a corresponding increase in statin usage. Statin prescriptions were 1.13 times more likely for participants who had comorbidity than for participants who did not have comorbidity. This finding aligns with research conducted in Germany [50], Scotland [51], and Malaysia [46]. Consequently, the presence of comorbidities like hypertension and diabetes ought to be recognized as posing a heightened risk for cardiovascular diseases. This recognition should prompt clinicians to intervene proactively, ensuring optimal care for these patients to prevent them from experiencing cardiovascular complications.

Participants with dyslipidemia were 3.15 times as likely to be prescribed statins as their counterparts without dyslipidemia. Similar findings have been reported in previous study [52]. It's evident that a patient diagnosed with dyslipidemia requires a prescription for statins. Individuals diagnosed with type 2 diabetes commonly exhibit a higher occurrence of lipid irregularities, which significantly heightens their susceptibility to atherosclerotic cardiovascular disease (ASCVD). Moreover, as their lifespan extends, the metabolic risk escalates, necessitating lipid-lowering therapy for these patients. Statins were 1.36 times as likely to be prescribed for participants with DM duration greater than ten years the participants with DM duration less than 10 years old. This result is consistent with findings from earlier research [53]. This result provides reassurance, as prolonged diabetes duration correlates with a heightened risk of cardiovascular disease (CVD). Consequently, guidelines advocate for statin therapy for diabetic patients exceeding a ten-year duration [54]. The finding implies that clinicians appropriately acknowledge an extended duration of diabetes as a cue for initiating statin therapy. Since there might be a lag in information dissemination between clinicians and patients, the adoption of new medications likely becomes smoother with longer durations of diabetes. Participants with government insured were 8.85 times more likely to be prescribed statins as their counterparts without insurance as noted in similar studies [55]. This could be attributed to the convenient availability of these medications through insurance coverage, thereby facilitating their prescription.

4.1. Strength and limitations

The authors utilized significant major databases to conduct searches for original research articles, which served as a notable strength of their review. The findings of this study are subject to significant limitations. Firstly, it relies solely on observational study designs. Secondly, it is confined to English-language literature. Thirdly, it focuses exclusively on type 2 diabetic patients. Consequently, the authors suggest further research incorporating alternative study designs and encompassing both type 1 and type 2 diabetes patients.

5. Conclusions and recommendations

In general, the extent of statin prescriptions for individuals with type 2 diabetes who are eligible for statin therapy was below the target outlined by clinical practice guidelines. Being over 65 years old, having comorbidities, experiencing dyslipidemia, having type 2 diabetes for more than ten years, and having government insurance were all identified as independent factors predicting the prescription of statins. This finding is concerning and underscores the urgent need to enhance adherence to clinical practice guidelines for the well-being of this vulnerable population at high risk. Physicians should assess their patients' requirements for cardiovascular protective medications and provide guidance on the significance of statins. Prescription interventions should target hospital healthcare professionals who have the ability to optimize medication use for preventing cardiovascular disease in patients with type 2 diabetes mellitus. Efforts to improve prescription practices in clinics should concentrate on investigating the causes of low statin prescriptions, enhancing clinicians' familiarity with recommended guidelines, providing ongoing medical education, conducting periodic prescription audits, and sharing the results to enhance the quality of preventive care for patients with type 2 diabetes mellitus.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Not applicable since the studies used were systematic reviews and meta-analyses.

Funding

The author(s) received no financial support for the research, authorship, or publication of this article.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

CRediT authorship contribution statement

Worku Chekol Tassew: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Yeshiwas Ayale Ferede: Writing – original draft, Visualization, Data curation. Agerie Mengistie Zeleke: Writing – original draft, Visualization, Data curation.

Declaration of competing interest

The authors declare that they have no competing interests.

Acknowledgements

The authors would like to thank the authors of the included primary studies, which were used as sources of information to conduct this systematic review and meta-analysis.

Footnotes

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.metop.2024.100297.

Contributor Information

Worku Chekol Tassew, Email: workukid16@gmail.com.

Yeshiwas Ayale Ferede, Email: yeshiwas981@gmail.com.

Agerie Mengistie Zeleke, Email: ageriemengistie@gmail.com.

Abbreviations

ASCVD

Atherosclerotic cardiovascular disease

AOR

adjusted odds ratio

CVD

Cardiovascular Disease

LDL

Low Density Lipoprotein

Appendix A. Supplementary data

The following is the Supplementary data to this article.

Multimedia component 1
mmc1.doc (73.5KB, doc)

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Associated Data

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Supplementary Materials

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Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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