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Multicenter Study
. 2022 Feb 1;5(2):e2148030.
doi: 10.1001/jamanetworkopen.2021.48030.

Use of Lipid-, Blood Pressure-, and Glucose-Lowering Pharmacotherapy in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease

Adam J Nelson  1 , Emily C O'Brien  1 , Lisa A Kaltenbach  1 , Jennifer B Green  1 , Renato D Lopes  1 , Caryn G Morse  2 , Hussein R Al-Khalidi  1 , Vanita R Aroda  3 , Matthew A Cavender  4 , Tanya Gaynor  5 , Julienne K Kirk  2 , Ildiko Lingvay  6 , Melissa L Magwire  7 , Darren K McGuire  6   8 , Jonathan Pak  5 , Rodica Pop-Busui  9 , Caroline R Richardson  10 , Cagri Senyucel  11 , Michelle D Kelsey  1 , Neha J Pagidipati  1 , Christopher B Granger  1
Affiliations
Multicenter Study

Use of Lipid-, Blood Pressure-, and Glucose-Lowering Pharmacotherapy in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease

Adam J Nelson et al. JAMA Netw Open. .

Abstract

Importance: Based on contemporary estimates in the US, evidence-based therapies for cardiovascular risk reduction are generally underused among patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD).

Objective: To determine the use of evidence-based cardiovascular preventive therapies in a broad US population with diabetes and ASCVD.

Design, setting, and participants: This multicenter cohort study used health system-level aggregated data within the National Patient-Centered Clinical Research Network, including 12 health systems. Participants included patients with diabetes and established ASCVD (ie, coronary artery disease, cerebrovascular disease, and peripheral artery disease) between January 1 and December 31, 2018. Data were analyzed from September 2020 until January 2021.

Exposures: One or more health care encounters in 2018.

Main outcomes and measures: Patient characteristics by prescription of any of the following key evidence-based therapies: high-intensity statin, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) and sodium glucose cotransporter-2 inhibitors (SGLT2I) or glucagon-like peptide-1 receptor agonist (GLP-1RA).

Results: The overall cohort included 324 706 patients, with a mean (SD) age of 68.1 (12.2) years and 144 169 (44.4%) women and 180 537 (55.6%) men. A total of 59 124 patients (18.2% ) were Black, and 41 470 patients (12.8%) were Latinx. Among 205 885 patients with specialized visit data from the prior year, 17 971 patients (8.7%) visited an endocrinologist, 54 330 patients (26.4%) visited a cardiologist, and 154 078 patients (74.8%) visited a primary care physician. Overall, 190 277 patients (58.6%) were prescribed a statin, but only 88 426 patients (26.8%) were prescribed a high-intensity statin; 147 762 patients (45.5%) were prescribed an ACEI or ARB, 12 724 patients (3.9%) were prescribed a GLP-1RA, and 8989 patients (2.8%) were prescribed an SGLT2I. Overall, 14 918 patients (4.6%) were prescribed all 3 classes of therapies, and 138 173 patients (42.6%) were prescribed none. Patients who were prescribed a high-intensity statin were more likely to be men (59.9% [95% CI, 59.6%-60.3%] of patients vs 55.6% [95% CI, 55.4%-55.8%] of patients), have coronary atherosclerotic disease (79.9% [95% CI, 79.7%-80.2%] of patients vs 73.0% [95% CI, 72.8%-73.3%] of patients) and more likely to have seen a cardiologist (40.0% [95% CI, 39.6%-40.4%] of patients vs 26.4% [95% CI, 26.2%-26.6%] of patients).

Conclusions and relevance: In this large cohort of US patients with diabetes and ASCVD, fewer than 1 in 20 patients were prescribed all 3 evidence-based therapies, defined as a high-intensity statin, either an ACEI or ARB, and either an SGLT2I and/or a GLP-1RA. These findings suggest that multifaceted interventions are needed to overcome barriers to the implementation of evidence-based therapies and facilitate their optimal use.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nelson reported receiving grants from Diabetes Australia and the Royal Australasian College of Physicians. Dr O’Brien reported receiving grants from Novartis, Glaxo Smith Kline, and Bristol Myer Squib outside the submitted work. Dr Green reported receiving grants and personal fees from Boehringer Ingelheim/Lilly Alliance, Sanofi/Lexicon, Glaxo Smith Kline, and AstraZeneca; personal fees from Novo Nordisk, Hawthorne Effect, Pfizer, Regeneron Pharmaceuticals, and Bayer; and grants from Merck, GlaxoSmithKline, and Roche outside the submitted work. Dr Lopes reported receiving personal fees from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Merck, Portola; grants from Amgen; and grants and personal fees from Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi outside the submitted work. Dr Aroda reported receiving grants from Applied Therapeutics, Novo Nordisk, Sanofi, Eli Lilly and Company, and Fractyl; personal fees from Duke University, Liberum, Novo Nordisk, and Pfizer; and that her spouse is employed by Janssen and Merck outside the submitted work. Dr Cavender reported receiving grants and personal fees from Amgen, Boehringer Ingelheim, and Novo Nordisk; grants from AstraZeneca and Novartis; and personal fees from Merck and Edwards Lifesciences outside the submitted work. Dr Lingvay reported receiving personal fees from Duke Clinical Research Institute during the conduct of the study and personal fees from Novo Nordisk, Eli Lilly and Company, Merck, Janssen, Sanofi, Boehringer Ingelheim, Intarcia, Bayer, AstraZeneca, Target RWE, Mannkind, Valerita, AstraZeneca, and DataRevive and grants from Novo Nordisk, Sanofi, Merck, Pfizer, and Mylan outside the submitted work. Dr Magwire reported receiving personal fees from Novo Nordisk and Boehringer Ingelheim outside the submitted work. Dr McGuire reported receiving personal fees from Boehringer Ingelheim, Janssen, Sanofi, AstraZeneca, Merck, Pfizer, Novo Nordisk, Esperion, Lilly, Lexicon Pharmaceuticals, CSL Behring, Applied Therapeutics, Metavant, Afimmune, GlaxoSmithKline, Eisai, and Bayer outside the submitted work. Dr Pop-Busui reported receiving personal fees from Boehringer Ingelheim, Novo Nordisk, Bayer, and Averitas, grants from AstraZeneca and the National Institutes of Health, and serving as an associated editor for Diabetes outside the submitted work. Dr Senyucel reported owning stock in Eli Lilly and Company outside the submitted work. Dr Kelsey reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Pagidipati reported receiving personal fees and grants from Boehringer Ingelheim, Eli Lilly and Company, and AstraZeneca and grants from Amgen, Novo Nordisk, Novartis, Regeneron, Sanofi, and Verily Life Sciences outside the submitted work. Dr Granger reported receiving grants and personal fees from Boehringer Ingelheim, Bristol Myer Squib, Janssen, Pfizer, and Medtronic; grants from Akros Pharma, Apple, AstraZeneca, Daichi-Sankyo, and Novartis; and personal fees from AbbVie, Bayer, Boston Scientific, CeleCor, Correvio, Espero, Merck, Novo Nordisk, Rhoshan Pharmaceuticals, and Roche Diagnostics outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cohort Inclusion Flowchart
Figure 2.
Figure 2.. Proportions of Patients Receiving Evidence-Based Therapies for Diabetes and Atherosclerotic Cardiovascular Disease
D, Evidence-based therapy composite score was scored as 0, no evidence-based therapies; 1, 1 evidence-based therapy; 2, 2 evidence-based therapies; and 3, 3 evidence-based therapies.
See this image and copyright information in PMC

References

    1. Bancks MP, Ning H, Allen NB, et al. . Long-term absolute risk for cardiovascular disease stratified by fasting glucose level. Diabetes Care. 2019;42(3):457-465. doi:10.2337/dc18-1773 - DOI - PMC - PubMed
    1. Fox CS, Pencina MJ, Wilson PW, Paynter NP, Vasan RS, D’Agostino RB Sr. Lifetime risk of cardiovascular disease among individuals with and without diabetes stratified by obesity status in the Framingham Heart Study. Diabetes Care. 2008;31(8):1582-1584. doi:10.2337/dc08-0025 - DOI - PMC - PubMed
    1. Lloyd-Jones DM, Leip EP, Larson MG, et al. . Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation. 2006;113(6):791-798. doi:10.1161/CIRCULATIONAHA.105.548206 - DOI - PubMed
    1. Nelson AJ, Peterson ED, Pagidipati NJ. Atherosclerotic cardiovascular disease and heart failure: determinants of risk and outcomes in patients with diabetes. Prog Cardiovasc Dis. 2019;62(4):306-314. doi:10.1016/j.pcad.2019.07.001 - DOI - PubMed
    1. Perel P, Avezum A, Huffman M, et al. . Reducing premature cardiovascular morbidity and mortality in people with atherosclerotic vascular disease: the World Heart Federation roadmap for secondary prevention of cardiovascular disease. Glob Heart. 2015;10(2):99-110. doi:10.1016/j.gheart.2015.04.003 - DOI - PubMed

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