Abstract 12292: Lipid-Lowering Therapy and LDL-C Control for Primary Prevention in Persons With Diabetes Across 90 Health Systems in the United States

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in persons with type 2 diabetes, and national guidelines recommend statin therapy for primary prevention of ASCVD in persons with type 2 diabetes (T2DM). Aim: To evaluate the degree of utilization of appropriate intensity statin therapy for primary prevention in patients with T2DM in community practice. Methods: We evaluated lipid-lowering therapy (LLT) and LDL-cholesterol (LDL-C) levels in patients aged 40–75 years with T2DM but without atherosclerotic cardiovascular disease (ASCVD), across 90 health systems in the United States participating in an EHR-derived dataset, Cerner Real World Data at baseline and one year follow-up. Multivariable logistic regression was used to evaluate factors associated with guideline-recommended (moderate- to high-intensity) statin therapy use. Results: We identified 241,232 patients with T2DM (58.1% on appropriate statin, 7.0% on low-intensity statin, and 34.9% on no statin. Predictors of appropriate statin therapy included retinopathy (adjusted odds ratio [aOR], 1.26; 95% CI, 1.15–1.38), hypertension [aOR 1.52 (1.43-1.61)], and stage 3 chronic kidney disease [CKD; aOR 1.14(1.07–1.21]. Women (aOR, 0.85, 95% CI, 0.82-0.87), and those with rheumatoid arthritis [aOR, 0.79 (0.71–0.87)], psoriasis [aOR, 0.85 (0.75–0.96)], and hepatitis C [aOR, 0.4 (0.39–0.46)] had reduced odds of appropriate statin treatment. Utilization of ezetimibe was rare (2.0%). LDL-C control was suboptimal (36.9% and 27.9% had LDL-cholesterol ≥100 mg/dL and <70 mg/dL, respectively). Therapy uptitration was infrequent; at one-year only 65.3% of patients were on appropriate statin intensity (Figure). Conclusions: Increased efforts are needed to improve primary prevention of ASCVD in adults with T2DM, particularly among women and those with risk-enhancing inflammatory conditions.