2197-P: The Impact of Lipid-Modifying Therapy (LMT) on 30-Year Non-HDL Cholesterol and Cardiovascular Disease (CVD) Is Similar by Sex in Type 1 Diabetes (T1D)

Introduction and Objective: Although hypercholesterolemia risks are established in T1D, sex differences in LMT effectiveness are under-explored and may explain some of the loss of female vascular protection in T1D. We examined if non-HDL-C and CVD associations differ by sex or LMT status over 30-years’ follow-up in the Pittsburgh Epidemiology of Diabetes Complications study of childhood-onset T1D (325 women; 333 men; baseline (1986-88) mean age 27, T1D duration 19 yrs). Methods: To address confounding by indication whereby higher risk patients are preferentially treated, we used doubly robust matched cohort analyses. Propensity scores for LMT initiation (WHO ATC code C10) were generated from demographic and clinical factors. We fit propensity-weighted Cox models to test the primary effect of time-varying non-HDL-C on CVD endpoints (Table 1), testing effect modification by sex and LMT with interaction terms. Results: N=313 initiated LMT (162 women; 151 men). At initiation, women had more favorable lipids and blood pressure (p<0.05). Despite these baseline differences, non-HDL-C was associated with time-to-CVD similarly across sex and LMT strata; no significant interactions were observed (Table 1). Conclusion: Non-HDL-C and CVD associations were similar regardless of sex or LMT. These results support current non-sex-specific lipid management guidelines in T1D. Disclosure B.M. Herbert: None. T. Costacou: None. S. El Khoudary: Consultant; Current; Novo Nordisk. T. Orchard: None. R.G. Miller: None. Funding American Diabetes Association (7-23-ICTSWH-19), NIDDK (R01DK034818)