Lack of secondary prevention therapy may affect diabetes, ASCVD odds
Among patients with diabetes and atherosclerotic CVD, the use of secondary prevention medications, including high-intensity statin and glucose-lowering therapies, was minimal, according to findings published in Circulation.
Suzanne V. Arnold, MD, MHA, and colleagues investigated the contemporary use of medication to reduce CV risk in a large cohort of U.S. patients with diabetes and ASCVD.
“Prior analyses reported suboptimal use of evidence-based therapies in this vulnerable group,” Arnold, a cardiologist at St. Luke’s Mid America Heart Institute in Kansas City, Missouri, and a Cardiology Today Next Gen Innovator, and colleagues wrote. “Given the emergence of nonstatin LDL-lowering agents and glucose-lowering medications with cardiovascular benefits, the number of evidence-based therapies for secondary prevention has expanded.”
The researchers analyzed the data from the GOULD registry for cholesterol management. Criteria for the guideline-recommended optimal medical therapy among the patients included high-intensity statins, antiplatelet agents, ACE inhibitors and use of SGLT2 inhibitors or GLP-1 agonists.
Of the 5,006 patients enrolled between 2016 and 2018, 34.7% had diabetes (mean age, 67 years; 60% men; 33% with prior MI; 17% with HF).
Median LDL was 92 mg/dL (interquartile range [IQR], 78-114) and median triglycerides were 141 mg/dL (IQR, 102-196).
Among the cohort, 88% used statins, 45% of patients used high-intensity statins, 10% used ezetimibe, 72% used ACE inhibitors, 87% used an antiplatelet agent or anticoagulant and 0.9% were on triple therapy, Arnold and colleagues wrote. Use of SGLT2 inhibitors was 9%, whereas GLP-1 receptor agonist use was 8% and fewer than 20% of patients used sulfonylureas.
According to the researchers, 6.9% of the patients received therapy that met the definition of optimal medical management for secondary prevention. The rate of therapy was lower in patients treated by cardiologists compared with patients treated by noncardiologists (5.6% vs. 8%; P = .057).
“Given the high cardiovascular event rates in this patient population, improving use of these guideline-recommended therapies is an important potential opportunity to improve care and, in turn, reduce the risk of recurrent ASCVD events, heart failure, hospitalizations and cardiovascular mortality,” Arnold and colleagues wrote. – by Earl Holland Jr.
Disclosures: The study was funded by Amgen. Arnold is an employee of Amgen. Please see the study for all other authors’ relevant financial disclosures.