SAN DIEGO – In the 3 months before their atherosclerotic cardiovascular event, 40% of high-risk patients with diabetes received no prescription for lipid-lowering therapy, researchers reported at the annual scientific sessions of the American Diabetes Association.
Underprescribing of high-intensity statins was also “particularly apparent for patients with diabetes mellitus alone, although rates improved somewhat over follow-up,” Sarah S. Cohen, PhD, of EpidStat Institute in Ann Arbor, Mich., said in a late-breaking poster. The findings highlight the need to educate providers and patients on the importance of addressing cardiovascular risk factors and disease in the diabetes setting, she wrote with her associates from the Mayo Clinic and Amgen.
Hypertension and dyslipidemia are classic companions of type 2 diabetes and “clear risk factors” for atherosclerotic cardiovascular disease (ASCVD), according to 2017 care guidelines from the American Diabetes Association.
“Diabetes itself confers independent risk,” the guidelines add. To characterize real-world use of lipid-lowering therapies in patients with diabetes, ASCVD, or both conditions, Dr. Cohen and her associates analyzed electronic medical records from more than 7,400 adults in Minnesota with new-onset type 2 diabetes mellitus or ASCVD, or incident ASCVD and existing diabetes between 2005 and 2012. During this period, about 4,500 patients were diagnosed with diabetes and another 570 patients with an existing diagnosis of diabetes were diagnosed with ASCVD based on incident myocardial infarction, unstable angina, stroke, or revascularization. An additional 2,300 patients had ASCVD alone.
Patients with existing diabetes and incident ASCVD tended to be in their 70s, two-thirds had used tobacco, 31% were overweight, and 54% were obese, the investigators found. Nonetheless, 40% of patients received no lipid-lowering therapy in the 3 months before the ASCVD event and 90% received no high-intensity statins. Three months after the event, 75% of patients were on lipid-lowering therapy and 64% were on moderate- or high-intensity statins. Patients with incident diabetes alone tended to be in their late 50s, about 60% had used tobacco, and two-thirds were obese. Only 34%, however, were prescribed moderate or high-intensity statins within 3 months after their diabetes diagnosis, and this proportion rose to just 46% at 2 years.
Diabetes is known to boost the risk of cardiovascular disease, but incident diabetes seldom triggered a prescription for lipid-lowering therapy in this cohort, the researchers concluded. Incident ASCVD was much more likely to elicit a prescription, but comorbid diabetes did not further improve the chances of receiving guideline-recommended therapy.
The ADA recommends screening for and treating modifiable CVD risk factors even in the prediabetes setting. For patients with clinical diabetes, providers should evaluate history of dyslipidemia, obtain a fasting lipid profile, and recommend lifestyle changes to address glycemic, blood pressure, and lipid goals, ADA guidelines state. In addition, comorbid diabetes and ASCVD merit high-intensity statin therapy, and diabetic patients with additional risk factors for CVD merit consideration of moderate- or high-intensity statin therapy, according to the recommendations.
The researchers lacked data on prescription fill rates, so they might have overestimated the proportion of patients taking lipid-lowering therapies, they noted. They also had no data on reasons for not prescribing lipid-lowering therapies.
Amgen and the National Institute on Aging provided funding. Dr. Cohen disclosed research funding from Amgen, which makes evolocumab, a lipid-lowering drug. She had no other conflicts of interest.