1429-P: Use of Guideline-Recommended Risk-Reduction Strategies among Patients with Type 2 Diabetes and Established ASCVD: A 1-Year Update from Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD)

Abstract

Due to emerging evidence, recent practice guidelines are emphasizing more aggressive use of effective prevention strategies in high-risk patients with diabetes (DM). We assessed changes in the use of evidence-based therapies among pts with DM from a registry of 5006 U.S. participants (pts) with ASCVD and LDL-C ≥70mg/dL across 120 U.S. centers taking lipid-lowering therapy (LLT). Among 1,622 DM pts with 12-month follow-up, 14% had intensification of LLT since baseline, 7% de-escalated. Median LDL-C at 12 months was 81 mg/dL, an 11% decrease from baseline. Among pts in the LDL-C cohorts, the percentage with LDL-C <70mg/dL increased from baseline through 12 months (Table). Use of statins and high-intensity statins was stable, while ezetimibe increased, and PCSK9i’s were initiated in 3% of pts not on a PCSK9i at enrollment. Use of SGLT2i, GLP-1RA’s, and fish oil did not change. At 12 months, 8% were on all guideline-recommended therapies for optimal risk reduction, similar to 7% at baseline (p for trend=0.1). Although some modest improvements in the use of secondary cardiovascular prevention therapies were observed, the proportion of patients with DM and ASCVD that receive optimal guideline-recommended risk reduction strategies remains very low. Disclosure M.N. Kosiborod: Consultant; Self; Amarin Corporation, Amgen, Applied Therapeutics, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., Eli Lilly and Company, GlaxoSmithKline plc., Glytec, Intarcia Therapeutics, Janssen Scientific Affairs, LLC., Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi US, Vifor Pharma Group. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. S.V. Arnold: None. J. Delemos: Consultant; Self; Amgen, Novo Nordisk A/S, Regeneron Pharmaceuticals. R.S. Rosenson: Advisory Panel; Self; Amgen, Medicines Company. Consultant; Self; CVS Caremark. Research Support; Self; Amgen, Medicines Company, Novartis Pharmaceuticals Corporation, Regeneron Pharmaceuticals. Other Relationship; Self; Amgen, Kowa Pharmaceuticals America, Inc., UpToDate. C.M. Ballantyne: Consultant; Self; Abbott, Akcea Therapeutics, Amarin Corporation, Amgen, Arrowhead Pharmaceuticals, Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Corvidia, Denka-Seiken Co., Ltd., Esperion Therapeutics, Inc., Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc., Matinas BioPharma, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Regeneron Pharmaceuticals, Roche Diagnostic USA, Sanofi. Research Support; Self; Abbott, Akcea Therapeutics, Amgen, Esperion Therapeutics, Inc., Novartis Pharmaceuticals Corporation, Regeneron Pharmaceuticals, Roche Diagnostic USA. Y. Liu: None. K.E. Mues: Employee; Self; Amgen. Stock/Shareholder; Self; Amgen. S. Alam: Employee; Self; Amgen. D.L. Bhatt: Research Support; Self; Abbott, Afimmune, Amarin Corporation, Amgen, AstraZeneca, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Cardax, Chiesi USA, Inc., CSL Behring, Ferring Pharmaceuticals, Fractyl Laboratories, Inc., Idorsia, Ironwood Pharmaceuticals, Ischemix, Lexicon Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Pfizer Inc., PhaseBio Pharmaceuticals, Inc., PLx Pharma Inc., Regeneron Pharmaceuticals, Roche Pharma, Sanofi-Aventis, Synaptic. C. Cannon: None. Funding Amgen Inc.