Abstract 13548: Impact of Guideline-Directed Statin Intervention for Primary Prevention in Patients With Diabetes Mellitus

Abstract

Background: The 2018 ACC/AHA Guidelines suggest patients with diabetes mellitus should receive moderate-high intensity statin therapy for primary prevention of ASCVD. We investigated diabetic and non-diabetic patients to evaluate the magnitude of benefit of guideline-directed statin intervention (GDSI) in each cohort. Methods: Primary prevention patients were categorized into diabetes (HbA1c>6.5%) and no-diabetes and stratified based on 10-year ASCVD risk (Borderline [5%-7.4%], Intermediate [7.5-19.9%], or High [>20%]). GDSI prior to first event was determined to be moderate to high intensity statin therapy for moderate and high-risk groups. Mean (±SD) time to start/change to GDSI was calculated from first interaction in health care. Cox regression assessed HRs of myocardial infarction (MI), stroke, and mortality with statin use. Results: Among 282,298 patients, 253,491 were non-diabetic and 28,807 had diabetes. Among diabetic patients at intermediate and high-risk, about 50% received GDSI initially, which rose to about two-thirds at 5y. In fully adjusted models, no statin use showed a higher risk of MI, stroke, and mortality compared to GDSI in all patients (Table). Compared to non-diabetics, diabetics on no statin versus GDSI had a higher risk of mortality and stroke in both intermediate risk [HR mortality 2.18 (1.79-2.65) vs 1.58 (1.45-2.72); all p<0.01] and high risk [HR mortality 1.81 (1.58-2.07) vs 1.41 (1.26-1.57); all p<0.01] groups (Table). Interaction analysis for mortality was significant (p<0.001) by diabetes status. Low statin vs GDSI did not significantly increase risk of ASCVD, except for mortality in the high-risk diabetes group. Conclusions: Significant gaps remain in achieving GDSI, and diabetic patients not treated with GDSI have a higher risk for adverse outcomes, specifically mortality, than non-diabetics. We must develop more aggressive measures to achieve GDSI in all patients, particularly those at highest cardiovascular risk.