Abstract 18302: Impact of Guideline-Directed Statin Intervention in Secondary Prevention Patients Stratified by Diabetes Status

Abstract

Background: The 2018 ACC/AHA Cholesterol guidelines recommend that patients with diabetes and known ASCVD should be prescribed high-intensity statin therapy. We analyzed statin use and associated ASCVD outcomes in patients with diabetes and ASCVD across a healthcare network. Methods: Using EMR data, statin utilization was analyzed on patients with established ASCVD (CAD, ischemic stroke, TIA and PAD) stratified by diabetes status. Statin use was divided as: (1) no statin , (2) less than guideline-directed statin intensity (<GDSI), and GDSI. Cox regression models were used to assess HRs and incidence rate per 1000-person years for secondary ASCVD outcomes (MI, ischemic stroke/TIA and all-cause death) in the population. Results: Over a median follow up of 6 years, out of 38,309 secondary prevention patients, 34.3% had diabetes. Over 30% of patients in both groups received no statin or <GDSI. Patients with diabetes and no statin use had higher incidence of MI (107 vs 37 per 1000PY), stroke (44 vs 17) and death (122 vs 45) than those on GDSI. In comparison to GDSI, patients receiving <GDSI or no statin were at significantly higher risk for all adverse outcomes in a graded manner (Table). Conclusions: In a contemporary real-world practice, there is an underutilization of GDSI amongst patients with known ASCVD with or without diabetes. Patients with diabetes suffer worse consequences as a result of this underuse. Efforts to ensure guideline implementation and optimal statin use can curtail burden of future ASCVD events.