Abstract 142: Patterns and Predictors of Intensive Statin Therapy among Patients with Type 2 Diabetes Mellitus after an Acute Myocardial Infarction

Abstract

Background: Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) are at increased risk for death and recurrent AMIs. Intensive statin therapy, a key component of aggressive risk factor management, has been shown to improve AMI outcomes especially in such a high risk population. However the frequency and predictors of intensive statin therapy among patients with DM after an AMI has not yet been described. Methods: We examined patterns of intensive statin therapy at discharge among AMI patients with prevalent DM enrolled in a 24-site US registry (TRIUMPH). Intensive statin therapy was defined as discharge on a statin with an expected LDL lowering of >50% (i.e., 80mg of atorvastatin or ≥20mg of rosuvastatin). We investigated the association of patient characteristics (including DM duration, DM treatment type and HbA1c levels) with intensive statin therapy at discharge using hierarchical modified Poisson models. Results: The analysis cohort was comprised of 1,319 patients with DM who were discharged alive after an AMI; mean age was 60 years, 41% women, 42% nonwhite and mean HbA1c of 8.3. At hospital discharge, only 21% were prescribed intensive statin therapy. In the multivariable model, ST-elevations on arrival, statin use on admission and higher LDL levels were independent predictors of intensive statin therapy. DM duration, HbA1C, and DM treatment type were not associated with intensive statin therapy (Figure). Conclusion: In a large, multicenter registry, only 1 in 5 patients with DM were prescribed intensive statin therapy at discharge after an AMI. While type of AMI, and LDL levels did correlate with intensive statin therapy upon discharge, neither DM duration nor severity was significantly associated with intensive statin therapy. These observations suggest an under-recognition of the high-risk nature of these patients and represent an opportunity for systems improvement to optimize prescription of high-intensity statins, in accordance with evidence-base.