Fewer than 60% of diabetic individuals in the United States meet low-density lipoprotein cholesterol (LDL) objectives for the prevention of atherosclerotic cardiovascular disease (ASCVD). Examining the timing of commencement of ASCVD primary preventive interventions following diabetes diagnosis may uncover actionable gaps in diabetes management. Researchers looked at people in the VA Health Care System who were newly diagnosed with diabetes and had no known ASCVD or a prior statin prescription at the time of diagnosis. First, using the AHA/ACC pooled cohort equation (PCE), they classified 10-year ASCVD risk as <7.5%, 7.5-20%, or ≥20% at the time of diabetes diagnosis. Then, using multivariable Cox proportional hazards regression adjusted for baseline HbA1c, body mass index, and glomerular filtration rate, they compared statin initiation, LDL trajectories, and achieving target LDL (defined as two consecutive values of 100 mg/dL) within the first 5 years after diabetes diagnosis across ASCVD risk categories.
Within 5 years, 41,763 (57.4%) of 72,757 persons who were statin-naive at the time of diabetes diagnosis have been prescribed a statin. The cumulative incidence of 5-year statin start rose in individuals with moderate (hazard ratio [HR] 1.11 [1.08, 1.1], P<0.001) and high risk (HR 1.19 [1.15, 1.22], P<0.001) ASCVD risk. LDL levels fell in all participants following a diabetes diagnosis, with higher drops in those with intermediate and high ASCVD risk. Within 5 years, 32,674 (58.5%) of the 55,844 patients who did not have target LDL at the time of diabetes diagnosis reached target LDL. Achievement of 5-year target LDL rose throughout ASCVD risk groups, with HR 1.22 [1.18, 1.28] (P<0.001) and HR 1.27 [1.22, 1.31] (P<0.001) in those with a 10-year risk of 7.5-20% and 20%, respectively, compared to those with 7.5% risk. Early after diabetes diagnosis, there are gaps in ASCVD primary prevention by statin medication and LDL lowering.
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