Keywords
Cardiovascular Disease
Statin
Lipid-Modifying Drugs
Retrospective observational analysis
Categories
How to Cite
Funding data
-
National Center for Advancing Translational Sciences
Grant numbers R01NS076491
Abstract
Introduction: Type 2 diabetes mellitus (T2DM) is associated with dyslipidemia and significantly increased cardiovascular risk, making lipid-modifying therapy a crucial preventive intervention in these patients. Despite clear guidelines recommending statin therapy for both primary and secondary prevention, real-world prescription routines and practices show gaps in clinical care. We aimed to evaluate the rates and patterns of lipid-modifying therapy under prescription among T2DM patients across U.S. healthcare facilities.
Methods: We conducted a retrospective observational analysis using the TriNetX US Collaborative Network database, including data from 69 healthcare organizations throughout the United States. Patients with T2DM patients aged 40-75 years were included in our cohort. Under-prescription rates were calculated and analyzed across demographic subgroups using standardized protocols within the TriNetX platform.
Results: Among 5,007,910 T2DM patients, we observed significant statin under-prescription rates. Our analysis showed a prescription rate of 55.1% for statins in eligible patients with T2DM.
Conclusions: Our findings revealed a significant under-prescription of lipid-modifying therapy in T2DM patients. The universal nature of under-prescription suggests barriers to guideline implementation. These results underscore the urgent need for systematic interventions, including automated identification systems, standardized protocols, and optimized provider education to improve cardiovascular risk management in patients with T2DM.
References
1. Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP, American Heart Association Council on E, Prevention Statistics C, Stroke Statistics S. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. 2024: e347 [PMID: 38264914, https://doi.org/10.1161/CIR.0000000000001209]
2. Wang Y, Wen Q, Lu Y, Yang J, Huang N, Chen W. Identifying subgroups benefiting from intensive glycaemic treatment to improve renal outcomes in type 2 diabetes: Insights from the ACCORD trial. Diabetes, obesity & metabolism. 2025: 1198 [PMID: 39654068, https://doi.org/10.1111/dom.16111]
3. Kim JH, Lee J, Han K, Kim JT, Kwon HS, Diabetic Vascular Disease Research Group of the Korean Diabetes A. Cardiovascular Disease & Diabetes Statistics in Korea: Nationwide Data 2010 to 2019. Diabetes & metabolism journal. 2024: 1084 [PMID: 39610135, https://doi.org/10.4093/dmj.2024.0275]
4. Park JH, Lim KT, Lee J, Gil Y, Sung J. The Diabetogenic Effect of Statin Use May Interact With Polygenic Risk Scores for Type 2 Diabetes: Evidence From the UK Biobank. Journal of preventive medicine and public health = Yebang Uihakhoe chi. 2025: 92 [PMID: 39668402, https://doi.org/10.3961/jpmph.24.671]
5. Kilpatrick ES, Kallner A, Atkin SL, Sathyapalan T. The variability of measured and calculated low-density lipoprotein (LDL) cholesterol in statin-treated diabetes patients. Annals of clinical biochemistry. 2025: 184 [PMID: 39636720, https://doi.org/10.1177/00045632241305936]
6. Usman NUB, Winson T, Basu Roy P, Tejani VN, Dhillon SS, Damarlapally N, Panjiyar BK. The Impact of Statin Therapy on Cardiovascular Outcomes in Patients With Diabetes: A Systematic Review. Cureus. 2023: e47294 [PMID: 38021726, https://doi.org/10.7759/cureus.47294]
7. Gami A, Blumenthal RS, McGuire DK, Sarkar S, Kohli P. New Perspectives in Management of Cardiovascular Risk Among People With Diabetes. Journal of the American Heart Association. 2024: e034053 [PMID: 38879449, https://doi.org/10.1161/JAHA.123.034053]
8. Cholesterol Treatment Trialists' Collaboration. Electronic address cnoau, Cholesterol Treatment Trialists C. Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis. The lancet Diabetes & endocrinology. 2024: 306 [PMID: 38554713, https://doi.org/10.1016/S2213-8587(24)00040-8]
9. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007: e296 [PMID: 17941714, https://doi.org/10.1371/journal.pmed.0040296]
10. Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, Sorensen HT, von Elm E, Langan SM, Committee RW. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015: e1001885 [PMID: 26440803, https://doi.org/10.1371/journal.pmed.1001885]
11. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC, Jr., Watson K, Wilson PW, American College of Cardiology/American Heart Association Task Force on Practice G. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014: 2889 [PMID: 24239923, https://doi.org/10.1016/j.jacc.2013.11.002]
12. Gudbjornsdottir S, Eeg-Olofsson K, Cederholm J, Zethelius B, Eliasson B, Nilsson PM, Swedish National Diabetes R. Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings from the Swedish National Diabetes Register (NDR). Diabet Med. 2009: 53 [PMID: 19125761, https://doi.org/10.1111/j.1464-5491.2008.02633.x]
13. Artac M, Dalton AR, Majeed A, Car J, Millett C. Effectiveness of a national cardiovascular disease risk assessment program (NHS Health Check): results after one year. Prev Med. 2013: 129 [PMID: 23701848, https://doi.org/10.1016/j.ypmed.2013.05.002]
14. Jiwa M, Meng X, Sriram D, Hughes J, Colagiuri S, Twigg SM, Skinner T, Shaw T. The management of Type 2 diabetes: a survey of Australian general practitioners. Diabetes Res Clin Pract. 2012: 326 [PMID: 22153417, https://doi.org/10.1016/j.diabres.2011.11.004]
15. Mann DM, Woodward M, Ye F, Krousel-Wood M, Muntner P. Trends in medication use among US adults with diabetes mellitus: glycemic control at the expense of controlling cardiovascular risk factors. Arch Intern Med. 2009: 1718 [PMID: 19822830, https://doi.org/10.1001/archinternmed.2009.296]
16. Johansen ME, Green LA, Sen A, Kircher S, Richardson CR. Cardiovascular risk and statin use in the United States. Ann Fam Med. 2014: 215 [PMID: 24821892, https://doi.org/10.1370/afm.1641]
17. Pokharel Y, Gosch K, Nambi V, Chan PS, Kosiborod M, Oetgen WJ, Spertus JA, Ballantyne CM, Petersen LA, Virani SS. Practice-Level Variation in Statin Use Among Patients With Diabetes: Insights From the PINNACLE Registry. J Am Coll Cardiol. 2016: 1368 [PMID: 27634128, https://doi.org/10.1016/j.jacc.2016.06.048]
18. Bonow RO. Primary prevention of cardiovascular disease: a call to action. Circulation. 2002: 3140 [PMID: 12485965, https://doi.org/10.1161/01.cir.0000048067.86569.e1]
19. McConnachie A, Walker A, Robertson M, Marchbank L, Peacock J, Packard CJ, Cobbe SM, Ford I. Long-term impact on healthcare resource utilization of statin treatment, and its cost effectiveness in the primary prevention of cardiovascular disease: a record linkage study. Eur Heart J. 2014: 290 [PMID: 23839541, https://doi.org/10.1093/eurheartj/eht232]
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