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Use of Guideline Directed Lipid Lowering Therapy among Patients with Diabetes without ASCVD in a Large Cardiology Practice
Journal article   Peer reviewed

Use of Guideline Directed Lipid Lowering Therapy among Patients with Diabetes without ASCVD in a Large Cardiology Practice

Dean G. Karalis, Joshua Hamsher, Nathan Wong, Nina Mirachi, Scott Hessen and Edward Laporta
Journal of clinical lipidology, v 16(1), pp e4-e4
Jan 2022
DOI: https://doi.org/10.1016/j.jacl.2021.09.008

Abstract

Nothing to disclose. None. Patients with diabetes mellitus (DM) are considered high-risk for ASCVD. Current guidelines recommend a moderate to high-intensity statin for the primary prevention of ASCVD in adult patients with DM and once on a maximally tolerated statin icosapent ethyl if with multiple risk factors and elevated triglycerides. To assess adherence with these guidelines among cardiologists in a single large cardiology practice. We identified 8,834 patients (age > 20) with DM and no history of ASCVD who had at least one office visit between December 2019 and November 2020. Patient characteristics, laboratory data and medications were extracted from their electronic health record (EHR). The mean age was 67.8 +/- 12.1 years, 50.4% were female and 70.1% were white. In total 1,707 (19.3%) were on no statin therapy, 472 (7.9%) on low intensity statin, and 6,645 (75.3%) on guideline directed statin therapy (moderate to high intensity). Among patients aged 40 to 75, 74.2% were on guideline directed statin therapy. Of the 8,834 patients: 7,213 (81.6%) had an LDL-C in their EHR, of which 1,541 (21.4%) had an LDL-C > 100 mg/dL. Of patients with an LDL-C > 100 mg/dL, only 145 (9.4%) were on either ezetimibe or a bile acid sequestrant. In total 7,194 patients had a triglyceride level in their EHR, of which 2,583 (30.8%) had elevated triglycerides (> 150 mg/dL). In patients with elevated triglycerides, 66.7% were on no triglyceride lowering medication, 10.6% were on a fibrate, 10.4% on over-the-counter fish oil, 5.8% on omega-3 fatty acid ethyl ester, 5.5% on icosapent ethyl (6.1% for triglycerides > 150 and LDL-C < 100 mg/dL), and 1.0% on niacin. Over one-fourth of patients with DM without ASCVD in a large cardiology practice are on no statin or on a lower than guideline directed statin intensity and over 1 in 5 have an LDL-C > 100 mg/dL. High triglycerides are common, often not treated and when treated the most common medications are a fibrate or over-the-counter fish oil. The use of icosapent ethyl is low. There is a need to identify strategies to improve the delivery of guideline directed lipid-lowering therapy to reduce residual ASCVD risk in those with DM.

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