Key result
Omitting statins in higher-risk diabetes is linked to ~81% greater mortality vs guideline-directed therapy.
Why the study?
The study examined the use of guideline-directed statin intensity and its association with atherosclerotic cardiovascular disease outcomes in patients with diabetes across a contemporary health care system.
Does guideline-directed statin intensity therapy reduce incident ASCVD and all-cause mortality in patients with diabetes without preexisting ASCVD?
Cohort (n=282,298)
Does guideline-directed statin intensity therapy reduce incident ASCVD and all-cause mortality in patients with diabetes without preexisting ASCVD?
Significant gaps remain in guideline-directed statin use for high-risk patients with diabetes, which is associated with an increased risk of ASCVD outcomes and all-cause mortality.
Statin nonuse was associated with higher mortality in high-risk diabetes; leaves open whether guideline-directed therapy reduces events in primary prevention.
OBJECTIVE: We examined guideline-directed statin intensity (GDSI) use and atherosclerotic cardiovascular disease (ASCVD) outcomes in patients with diabetes across a contemporary health care system. RESEARCH DESIGN AND METHODS: Patients without preexisting ASCVD were categorized by diabetes status and 10-year ASCVD risk (borderline [5-7.4%], intermediate [7.5-19.9%], high [≥20%]). Mean ±SD time to start of or change to GDSI was calculated. Incident ASCVD and all-cause mortality association, stratified by ASCVD risk, was calculated using Cox regression. RESULTS: Among 282,298 patients, 28,807 (10.2%) had diabetes and 253,491 (89.8%) did not. Only two-thirds of intermediate- and high-risk patients with diabetes were receiving GDSI therapy at 5-year follow-up. In fully adjusted models, patients with diabetes not taking a statin (vs. GDSI) had a significantly higher risk of stroke and mortality in the intermediate- and high-risk groups (hazard ratio for mortality 1.81 [95% CI 1.58-2.07] vs. 1.41 [1.26-1.57]; P for interaction < 0.01). CONCLUSIONS: Significant gaps remain in GDSI use for high-risk patients with diabetes, conferring an increased risk of ASCVD outcomes and all-cause mortality.
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Muluk et al. (2023) conducted a cohort in Diabetes without preexisting ASCVD (n=282,298). Not taking a statin vs. Guideline-directed statin intensity (GDSI) was evaluated on Incident ASCVD and all-cause mortality (HR 1.81, 95% CI 1.58-2.07, p=< 0.01). Patients with diabetes at intermediate or high risk not taking a statin had a significantly higher risk of mortality compared to those on guideline-directed statin therapy (HR 1.81; 95% CI 1.58-2.07).
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