ArticleAmerican journal of preventive cardiology2023
Lipid-lowering therapy and LDL-C control for primary prevention in persons with diabetes across 90 health systems in the United States.
Article in American journal of preventive cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors at 2 institutions in 1 country.
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Abstract
Objective: National guidelines recommend statin therapy for patients with type 2 diabetes. We assessed the extent of moderate- to high-intensity statin therapy utilization in community practice. Methods: We evaluated lipid-lowering therapy (LLT) and low-density lipoprotein cholesterol (LDL-C) levels at baseline and 1-year follow-up in patients aged 40-75 years with type 2 diabetes but without atherosclerotic cardiovascular disease (ASCVD), across 90 health systems in the United States participating in an electronic health record-derived dataset, Cerner Real-World Data. Multivariable logistic regression was used to evaluate factors associated with utilization of moderate- to high-intensity statin. Results: We identified 241,232 patients with type 2 diabetes (58.1 % on moderate- to high-intensity statin, 7.0 % on low-intensity statin, and 34.9 % on no statin). Predictors of moderate- to high-intensity statin therapy included retinopathy (adjusted odds ratio [aOR], 1.26; 95 % confidence interval [CI], 1.15-1.38), hypertension (aOR, 1.52; 95 % CI, 1.43-1.61), and stage 3 chronic kidney disease (aOR, 1.14; 95 % CI, 1.07-1.21). Women (aOR, 0.85; 95 % CI, 0.82-0.87), and those with rheumatoid arthritis (aOR, 0.79; 95 % CI, 0.71-0.87), psoriasis (aOR, 0.85; 95 % CI, 0.75-0.96), and hepatitis C (aOR, 0.40; 95 % CI, 0.39-0.46), had reduced odds of moderate- to high-intensity statin treatment. Utilization of ezetimibe was rare (2.0 %). LDL-C control was suboptimal at baseline (37.0 % and 27.9 % had LDL-C ≥100 mg/dL and <70 mg/dL, respectively). At 1-year follow-up, the rate of moderate- to high-intensity statin therapy utilization was 65.3 %. Conclusion: Increased efforts are needed to improve LDL-C control and LLT use for primary prevention of ASCVD in adults with type 2 diabetes, in particular among women and those with risk-enhancing inflammatory conditions.
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