Impact of Guideline-Directed Statin Intervention for Primary Prevention in Patients With Diabetes

OBJECTIVE We examined guideline-directed statin intensity (GDSI) use and atherosclerotic cardiovascular disease (ASCVD) outcomes in patients with diabetes across a contemporary health care system. RESEARCH DESIGN AND METHODS Patients without preexisting ASCVD were categorized by diabetes status and 10-year ASCVD risk (borderline [5-7.4%], intermediate [7.5-19.9%], high [ ≥20%]). Mean \pm SD time to start of or change to GDSI was calculated. Incident ASCVD and allcause mortality association, stratified by ASCVD risk, was calculated using Cox regression. RESULTS Among 282,298 patients, 28,807 (10.2%) had diabetes and 253,491 (89.8%) did not. Only two-thirds of intermediate- and high-risk patients with diabetes were receiving GDSI therapy at 5-year follow-up. In fully adjusted models, patients with diabetes not taking a statin (vs. GDSI) had a significantly higher risk of stroke and mortality in the intermediate- and high-risk groups (hazard ratio for mortality 1.81 [95% Cl 1.58-2.07] vs. 1.41 [1.26-1.57]; P for interaction <0.01). CONCLUSIONS Significant gaps remain in GDSI use for high-risk patients with diabetes, conferring an increased risk of ASCVD outcomes and all-cause mortality.