Abstract 007: Titration From Low/moderate to High Intensity Statins Following Myocardial Infarction Among Patients With Diabetes

Abstract

Background: High intensity statins have been shown to lower the risk of major cardiovascular events after a myocardial infarction (MI). Recent studies report that most people with diabetes who experience a coronary heart disease event are already taking a statin, but little is known about the percentage who are titrated to a high intensity statin following hospital discharge for a MI. Methods: We compared the percentage of patients with versus without diabetes who titrated from a low/moderate to a high intensity statin within 30 days following hospital discharge for MI in 2014. The analyses included 3,629 patients with diabetes and 3,502 patients without diabetes. All patients were 66 to 74 years of age, had government insurance through Medicare, and filled a low/moderate intensity statin without any high intensity statin fills within 365 days prior to having a MI. Also, all patients filled a statin within 30 days following hospital discharge. Statin fills were identified through pharmacy claims; high intensity statins included atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg. Results: Titration from low/moderate to high intensity statins following hospital discharge for MI occurred among 37.7% and 43.7% of beneficiaries with and without diabetes, respectively. After adjustment for demographics, low socioeconomic status and comorbidities, having diabetes was not associated with titrating to a high intensity statin following hospital discharge (risk ratio [RR]: 1.03; 95% CI 0.96-1.10). Among those with diabetes, African Americans compared with whites (RR 1.16; 95% CI 1.02-1.32) and men compared with women (RR 1.14; 95% CI 1.05-1.25) were more likely to titrate from a low/moderate statin to a high intensity statin. Also, titration to a high intensity statin was less common among those with a history of heart failure (RR 0.79; 95% CI 0.69-0.90), those who had seen a cardiologist in the year prior to their MI (RR 0.90; 0.81-1.00), and those who had filled a non-statin lipid-lowering medication within 30 days following hospital discharge (RR 0.50; 95% CI 0.38-0.64). Titration to a high intensity statin was more common among those with diabetes filling a beta blocker (RR 1.15; 95% CI 1.02-1.28) or antiplatelet agent (RR 1.13; 95% CI 1.04-1.24) and attending cardiac rehabilitation (RR 1.22; 95% CI 1.09-1.36) within 30 days following hospital discharge. Only 9.0% of patients with diabetes whose first statin fill following hospital discharge was for a low/moderate-intensity dose filled a high intensity statin within the next 6 months. Conclusions: Most patients with diabetes do not titrate to a high intensity statin following hospital discharge for MI, potentially leaving substantial residual risk for recurrent MI. Further research into the under treatment of patients with diabetes is needed.