Abstract
BackgroundCurrent guidelines recommend life-long use of statin for patients with type 2 diabetes (T2D), however, a number of patients discontinue statin therapy in clinical practice. We aimed to estimate the optimal statin therapy including statin therapy duration, statin intensity, and low-density lipoprotein cholesterol (LDL-C) level among patients with T2D in a real-world setting.MethodsFrom Korean National Health Insurance Service Cohort (2007–2015), 8937 patients with T2D (≥ 40 years of age) who received statin therapy for at least 90 days were included. Risk of major adverse cardiovascular event (MACE) including ischemic heart disease, ischemic stroke, and cardiovascular death was estimated according to statin intensity, achieved serum LDL-C level, and statin therapy duration, respectively. The relative contributions of these factors to MACE risk were quantified by calculating the proportion of log-likelihood explained by each factor.ResultsThe hazard ratio (HR) of MACE was lower in patients receiving moderate- or high-intensity statins than in those receiving low-intensity statins (HR, 0.72; p = 0.027). Among patients who received moderate- or high-intensity statins, lower achieved LDL-C level was associated with lower cardiovascular risk. Notably, the longer the patients received statins, the lower was the risk of MACE; the HR of MACE was significantly reduced after at least 18 months (adjusted HR, 0.70; p = 0.009) as a reference to 3–6 months of therapy. The proportion of explainable log-likelihood for MACE was greatest for statin duration (2.55), followed by achieved LDL-C level (2.18), and statin intensity (0.95).ConclusionsStatin therapy duration is as important as or more crucial than statin intensity or achieved LDL-C level for the reduction of cardiovascular risk in T2D patients. The concept of “longer is better” regarding statin therapy should be considered in clinical practice.
Highlights
Current guidelines recommend life-long use of statin for patients with type 2 diabetes (T2D), a number of patients discontinue statin therapy in clinical practice
We evaluated the association between achieved low-density lipoprotein cholesterol (LDL-C) levels and the risk of major adverse cardiovascular event (MACE)
The longer the patients received statins, the lower was the risk of MACE
Summary
Current guidelines recommend life-long use of statin for patients with type 2 diabetes (T2D), a number of patients discontinue statin therapy in clinical practice. Previous studies reported that LDL-C lowering with statin therapy substantially reduces the risk of atherosclerotic cardiovascular events in patients with T2D [3,4,5], current guidelines for dyslipidemia management generally recommend life-long use of moderate- or high-intensity statins in adult patients with T2D [6, 7]. The so-called statin and LDL-C hypotheses have been supported by evidence provided by randomized controlled trials (RCT) These hypotheses are often not reproducible in populationbased studies [8], probably due to biases that are difficult to control. Despite the numerous trials of statins, there are only few studies targeted patients with T2D [4, 15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
