Delays in Statin Therapy Due to Nonacceptance Linked to Poor Cardiovascular Outcomes in Diabetic Patients: Study

The study, published in the journal Diabetes and presented at the American Diabetes Association 84th Scientific Sessions, showed that patients with diabetes without atherosclerotic cardiovascular disease (ASCVD) who delay statin therapy due to statin non-acceptance have an increased risk of cardiovascular (CV) events.

The finding identifies a previously unexplored gap in care that increases the CV burden in this already high-risk population.

Diabetes is a known risk factor for cardiovascular disease, making effective management of cholesterol levels crucial in reducing associated risks. Statins are widely prescribed to lower cholesterol and prevent cardiovascular events in diabetic patients. However, the study focused on cases where patients delayed or refused statin therapy, leading to potential adverse consequences.

Many patients diagnosed with diabetes choose not to follow their clinicians' recommendations for statin therapy. The long-term clinical consequences of refusing statins remain uncertain. Considering this, Nisarg Shah, New Haven, CT, Boston, MA, Baltimore, MD, and colleagues conducted a retrospective cohort study of patients with diabetes without ASCVD treated at Mass General Brigham from 2000-2018. They analyzed the relationship between delay in statin therapy due to statin non-acceptance by patients and the incidence of CV events (ischemic stroke or myocardial infarction).

Information about baseline characteristics and statin non-acceptance was obtained from the electronic medical records and a previously validated Natural Language Processing tool.

The following were the key findings of the study:

• The mean age of 7,239 study patients was 55.0 years; 52.1% were female. Their mean baseline LDL-C was 138 mg/dl, and the mean HbA1c was 7.5%.
• 17.7% of patients delayed statin therapy (by a mean of 2.7 years, during which they had a mean of 4.6 provider visits) due to initial non-acceptance. These patients then continued on statin therapy for a mean of 7.1 years.
• Over the mean follow-up time of 8.2 years, 6.3% of patients had a CV event.
• Accounting for all-cause death as a competing risk, 6.4% of patients who accepted versus 8.5% of patients who initially declined statin therapy recommendation experienced a CV event at ten years.
• In a multivariable Cox analysis that adjusted for patients’ demographic characteristics and comorbidities and clustering within providers, initial non-acceptance of statin therapy was associated with an increased risk of a CV event (HR 1.49).

In conclusion, patients diagnosed with both type 1 and type 2 diabetes who postpone initiating statin therapy, recommended to mitigate their heightened risk of cardiovascular events, experience markedly increased rates of cardiovascular events during a 10-year follow-up period compared to those who begin treatment promptly.

Reference:

NISARG SHAH, ZHOU LAN, SETH S. MARTIN, C J. BROWN, ALEXANDER TURCHIN; 56-OR: Impact of Delays in Statin Therapy Due to Statin Nonacceptance on Cardiovascular Outcomes in Patients with Diabetes. Diabetes 14 June 2024; 73 (Supplement_1): 56–OR. https://doi.org/10.2337/db24-56-OR