Effectiveness and use of evidence-based cardiovascular preventive therapies in type 2 diabetes patients with established or high risk of atherosclerotic cardiovascular disease.

Aim: To explore the association of evidence-based cardiovascular preventive therapies with cardiovascular and renal outcomes in type 2 diabetes (T2DM) patients with established or high risk of atherosclerotic cardiovascular disease (ASCVD).

Methods: In this cohort study, we identified T2DM patients with established or high risk of ASCVD using diagnostic codes from the institutional data of Xiamen Humanity Hospital between 2018 and 2023. Cohort 1 includes participants who were visited between 2018 and 2020, with follow-up until occurrence of an endpoint or December 31, 2020. Participants who were visited between 2018 and 2023 were included in cohort 2. A total of 5,335 patients were included in cohort 1, and 17,320 patients were included in cohort 2. Primary outcomes were hazard ratios (HRs) for the composite of 3-point major adverse cardiovascular event (3-P MACE), hospitalization for heart failure (HHF), and end-stage kidney disease or doubling of serum creatinine level.

Results: Relative to patients' non-use of evidence-based cardiovascular preventive therapies, the use of at least one evidence-based cardiovascular preventive therapy was associated with a lower risk of the 3-P MACE (HR, 0.82; 95% confidence interval [CI], 0.67 to 0.98), HHF (HR, 0.66; 95% CI, 0.47 to 0.92) and end-stage kidney disease or doubling of the serum creatinine level (HR, 0.73; 95% CI, 0.60 to 0.89) after adjustment for potential confounders. From 2018 to 2023, the use of glucagon-like peptide 1 receptor agonists increased from 2.7% to 13.7%; sodium-glucose cotransporter 2 inhibitors increased from 3.9% to 16.5%; angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers increased from 28.1% to 43.0%; moderate-intensity statins increased from 61.6% to 70.5%; and aspirin increased from 23.7% to 32.9%.

Conclusions: This study demonstrated that T2DM patients with established or high risk of ASCVD might benefit from the use of evidence-based cardiovascular preventive medications with respect to the risk of 3-P MACE, HHF, and end-stage kidney disease or doubling of the serum creatinine level. Despite a modest annual increase in the use of evidence-based cardiovascular preventive medications in T2DM individuals with established or high risk of ASCVD, multiple strategies are needed to overcome barriers to the implementation of evidence-based therapies.