56-OR: Impact of Delays in Statin Therapy Due to Statin Nonacceptance on Cardiovascular Outcomes in Patients with Diabetes

IF 6.2 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes Pub Date : 2024-06-21 DOI:10.2337/db24-56-or

NISARG SHAH, ZHOU LAN, SETH S. MARTIN, C J. BROWN, ALEXANDER TURCHIN

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Abstract

Introduction: Many patients with diabetes do not accept their clinicians’ statin therapy recommendations. Long-term clinical sequalae of statin non-acceptance are unknown. Methods: We conducted a retrospective cohort study of patients with diabetes without ASCVD treated at Mass General Brigham in 2000-2018. We analyzed the relationship between delay in statin therapy due to statin non-acceptance by patients and the incidence of CV events (MI or ischemic stroke). Information about statin non-acceptance and baseline characteristics was obtained from the electronic medical records and a previously validated Natural Language Processing tool. Results: The mean age of 7,239 study patients was 55.0 (SD 11.9) years; 3,769 (52.1%) were female. Their mean baseline LDL-C was 138 (SD 28) mg/dl and the mean HbA1c was 7.5% (SD 1.9). A total of 1,280 (17.7%) of patients delayed statin therapy (by a mean of 2.7 (SD 3.1) years during which they had a mean of 4.6 (SD 9.1) provider visits) due to initial non-acceptance. These patients then continued on statin therapy for a mean of 7.1 (SD 4.8) years. Over the mean follow-up time of 8.2 (SD 4.6) years, 455 (6.3%) of patients had a CV event. Accounting for all-cause death as a competing risk, 6.4% (95% CI 5.6-7.2) of patients who accepted vs. 8.5% (95% CI 6.8-10.5) of patients who initially declined statin therapy recommendation experienced a CV event at 10 years (p = 0.001). 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 increased risk of a CV event (HR 1.49, 95% CI 1.16-1.91, p = 0.002). Conclusions: Our study shows that patients with diabetes without ASCVD who delay statin therapy due to statin non-acceptance have an increased risk of CV events. This finding identifies a previously unexplored gap in care that increases cardiovascular burden in this already high-risk population. Disclosure N. Shah: None. Z. Lan: None. S.S. Martin: Consultant; Amgen Inc., AstraZeneca, Bristol-Myers Squibb Company, Chroma, Kaneka Inc., NewAmsterdam, Novartis AG, Novo Nordisk, Premier, Sanofi. C.J. Brown: None. A. Turchin: Research Support; Eli Lilly and Company, Novo Nordisk. Consultant; Novo Nordisk, Proteomics International. Research Support; AstraZeneca. Funding PCORI (ME-2019C1-15328)

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56-OR：因不接受他汀类药物而延迟他汀类药物治疗对糖尿病患者心血管结果的影响

引言许多糖尿病患者不接受临床医生提出的他汀类药物治疗建议。不接受他汀类药物治疗的长期临床后果尚不清楚。研究方法我们对 2000-2018 年在麻省总医院布里格姆分院接受治疗的无 ASCVD 的糖尿病患者进行了一项回顾性队列研究。我们分析了因患者不接受他汀类药物而导致的他汀类药物治疗延迟与心血管事件（心肌梗死或缺血性卒中）发生率之间的关系。有关他汀类药物不被接受和基线特征的信息来自电子病历和之前验证过的自然语言处理工具。研究结果7,239 名研究患者的平均年龄为 55.0 岁（SD 11.9），其中 3,769 人（52.1%）为女性。他们的平均基线 LDL-C 为 138 (SD 28) mg/dl，平均 HbA1c 为 7.5% (SD 1.9)。共有 1,280 名患者（17.7%）因最初不接受他汀类药物治疗而推迟了治疗（平均推迟了 2.7 年（标准差 3.1 年），在此期间，他们平均接受了 4.6 次（标准差 9.1 次）医疗服务。这些患者继续接受他汀类药物治疗的平均时间为 7.1 年（标准差 4.8 年）。在平均 8.2 (SD 4.6) 年的随访时间内，455 例（6.3%）患者发生了冠心病事件。考虑到全因死亡这一竞争风险，接受他汀治疗建议的患者中有 6.4% （95% CI 5.6-7.2）在 10 年内发生过 CV 事件，而最初拒绝他汀治疗建议的患者中有 8.5%（95% CI 6.8-10.5）在 10 年内发生过 CV 事件（P = 0.001）。在对患者的人口统计学特征、合并症和医疗机构内的聚类进行调整的多变量 Cox 分析中，最初不接受他汀类药物治疗的患者发生 CV 事件的风险增加（HR 1.49，95% CI 1.16-1.91，p = 0.002）。结论我们的研究表明，因不接受他汀类药物而延迟他汀类药物治疗的无 ASCVD 的糖尿病患者发生 CV 事件的风险会增加。这一发现发现了一个以前未被发现的护理漏洞，它增加了这一高危人群的心血管负担。披露 N. Shah：无。Z. Lan：无。S.S. Martin：无：顾问；安进公司、阿斯利康、百时美施贵宝公司、Chroma、Kaneka Inc.、NewAmsterdam、诺华股份公司、诺和诺德、Premier、赛诺菲。C.J. 布朗：无。A. Turchin：研究支持；礼来公司、诺和诺德公司。顾问；诺和诺德、国际蛋白质组学协会。研究支持；阿斯利康。资助 PCORI (ME-2019C1-15328)

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来源期刊

Diabetes 医学-内分泌学与代谢

CiteScore

12.50

自引率

2.60%

发文量

1968

审稿时长

1 months

期刊介绍： Diabetes is a scientific journal that publishes original research exploring the physiological and pathophysiological aspects of diabetes mellitus. We encourage submissions of manuscripts pertaining to laboratory, animal, or human research, covering a wide range of topics. Our primary focus is on investigative reports investigating various aspects such as the development and progression of diabetes, along with its associated complications. We also welcome studies delving into normal and pathological pancreatic islet function and intermediary metabolism, as well as exploring the mechanisms of drug and hormone action from a pharmacological perspective. Additionally, we encourage submissions that delve into the biochemical and molecular aspects of both normal and abnormal biological processes. However, it is important to note that we do not publish studies relating to diabetes education or the application of accepted therapeutic and diagnostic approaches to patients with diabetes mellitus. Our aim is to provide a platform for research that contributes to advancing our understanding of the underlying mechanisms and processes of diabetes.