What does this research mean for the field?

Globally, patients with high-risk diabetes mellitus are frequently undertreated with lipid-lowering therapies, with fewer than half receiving treatment and only 22% achieving guideline-recommended LDL-C targets. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to evaluate lipid management patterns in patients with high-risk diabetes mellitus at increased cardiovascular risk.

June 7, 2026

1448-P: Lipid Management in Patients with High-Risk Diabetes Mellitus at Risk for a First Major Atherosclerotic Cardiovascular Event: Findings from the VESALIUS-REAL Global Study

Key Points

The study aims to evaluate lipid management patterns in patients with high-risk diabetes mellitus at increased cardiovascular risk.
Patients aged ≥ 50 years with coronary artery disease, atherosclerotic cerebrovascular disease, or peripheral artery disease or high-risk diabetes were analyzed from 11 databases (2017-2022).
Lipid-lowering therapy use, LLT intensification, and LDL-C goal achievement were summarized based on local guidelines for this subgroup.
A total of 354,643 patients with high-risk diabetes were included, with the index date defined as when all criteria were met.
46% of patients were on lipid-lowering therapy at the index date, predominantly on statin monotherapy (87%).
Only 26% of patients not on LLT at index initiated therapy within 1 year, and 7% of those on LLT intensified treatment during the same period.
42% underwent LDL-C testing in follow-up, and only 22% achieved their local guideline-recommended LDL-C goal.

Abstract

Introduction and Objective: American Diabetes Association (ADA) guidelines recommend early assessment of lipid levels in patients with diabetes mellitus (DM) and, in those at increased cardiovascular (CV) risk, initiation of lipid-lowering therapy (LLT) to reduce the risk of a first CV event and improve long-term outcomes. We examined lipid management patterns in patients with high-risk DM at risk for their first major atherosclerotic CV event in 11 databases from North America, Europe, and Asia-Pacific. Methods: Patients aged ≥ 50 years with coronary artery disease (CAD), atherosclerotic cerebrovascular disease (CeVD), or peripheral artery disease (PAD) or high-risk DM (defined as DM with microvascular complications or chronic insulin use) and elevated lipids and additional CV risk factors but no history of myocardial infarction or stroke were selected from de-identified claims or electronic medical records (2017-2022). The earliest date when all criteria were met was defined as the index. This analysis summarizes LLT use, LLT intensification, and low-density lipoprotein cholesterol (LDL-C) goal achievement based on local guidelines for the high-risk DM subgroup. Results: Out of 354,643 patients with high-risk DM (51% female), 14% also had CAD, atherosclerotic CeVD, or PAD. Fewer than half of the patients were on LLT at index (46%), and statin monotherapy was the predominant regimen (87%). For patients not on LLT at index, about 1 in 4 (26%) initiated LLT within 1 year post-index; for those who had ongoing LLT, 7% intensified their LLT within 1 year post-index. Around 42% of patients underwent LDL-C testing within 1 year of follow-up (n = 149,495), and 22% met their local guideline-recommended LDL-C goal. Conclusion: These findings show that globally, patients with high-risk DM are frequently untreated or undertreated, not having optimal lipid monitoring, and only a minority achieve ADA-recommended lipid management targets to lower the risk of major ischemic events. Disclosure Q. Chan: Employee; Current; Amgen Inc. S. Sakhuja: Employee; Current; Amgen Inc. M. Budoff: Speaker's Bureau; Current; Amgen Inc. Research Support; Current; Lilly. Speaker's Bureau; Current; Novo Nordisk A/S, Lilly. J. Cegla: Consultant; Current; Novartis Pharmaceuticals Corporation, Eli Lilly and Company, Amryt Pharma Plc, Amgen Inc., Daiichi Sankyo, Chiesi USA, Inc. J.H. Cornel: Advisory Panel; Current; Amgen Inc., Janssen Research Ended; Pfizer Inc. Consultant; Current; Amgen Inc. Research Support; Current; Amgen Inc. Advisory Panel; Ended; Amarin Corporation. Research Support; Current; Novo Nordisk. Advisory Panel; Ended; Novo Nordisk. Speaker's Bureau; Ended; Sanofi. Other - National lead coin trial; Current; AstraZeneca. Advisory Panel; Ended; Bayer AG. G. Paiva da Silva Lima: Employee; Current; Amgen Inc. Stock/Shareholder; Current; Amgen Inc. M. Sibartie: Employee; Current; Amgen Inc. Stock/Shareholder; Current; Amgen Inc. I.C. Wong: Research Support; Current; Amgen Inc.

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