Impact of Guideline-Directed Statin Intervention for Primary Prevention in Patients with Diabetes Mellitus
Objective: We examined guideline-directed statin intensity (GDSI) use and ASCVD outcomes in patients with diabetes across a contemporary healthcare system.
Research Design and Methods: Patients without pre-existing 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/change to GDSI was calculated. Incident ASCVD and all-cause mortality association, stratified by ASCVD risk, was calculated by Cox regression.
Results: Among 282,298 patients, 28,807 (10.2%) had diabetes while 253,491 (89.8%) did not. Only two-thirds of intermediate and high-risk patients with diabetes received GDSI at 5-year-follow up. In fully adjusted models, patients with diabetes on no statin (versus GDSI) had significantly higher risk of stroke and mortality in intermediate and high-risk [HRmortality 1.81 (1.58-2.07) vs 1.41 (1.26-1.57); p-value for interaction <0.01) groups.
Conclusions: Significant gaps remain in GDSI use for high-risk patients with diabetes, conferring increased risk of ASCVD outcomes and all-cause mortality.