Use of optimal medical therapy in patients with diabetes and atherosclerotic cardiovascular disease: Insights from a prospective longitudinal cohort study
Authors' conclusion
We found suboptimal use of secondary prevention in US patients with ASCVD and diabetes, with minimal improvement over time. Further efforts are needed to improve the use of secondary prevention therapies in these patients with high residual risk.
Study context
- Population
- Patients with atherosclerotic cardiovascular disease (ASCVD) (coronary, cerebrovascular, peripheral), LDL-C ≥70 mg/dl and diabetes (96% T2D), 107 US sites/physicians, enrolled December 2016 to July 201896% T2D
- Participants
- 1,590 patients
- Outcome
- Use of comprehensive OMT (high-intensity lipid-lowering, antithrombotic, ACE-I/ARB/ARNI and SGLT2i/GLP-1 RA)
- Follow-up
- end of 2-year follow-up
Methodological detailsmulticentre, subgroup with diabetes
- Multicentre
- Subgroup with diabetes
Main finding
As reported in the abstract
Comprehensive OMT · end of follow-up
- Comprehensive optimal medical therapy (OMT), end of follow-up
- 11%
- Comprehensive OMT at baseline
- 8%
- Improvement over time
- P = .002
Observational data: associations, not effects.
Further findings
Composite OMT by treating physician · lower with cardiologists
P < 0.001
Use of each therapy class · end of follow-up
- High-intensity lipid-lowering therapy
- 58%
- Antithrombotic
- 87%
- ACE-I/ARB/ARNI
- 71%
- SGLT2i/GLP-1 RA
- 17%
Composite OMT by treating physician
- Patients of cardiologists more likely on high-intensity lipid lowering but less likely on SGLT2i/GLP-1 RA
Factors associated with OMT (hierarchical multivariable model)
- Older age, per 10 years: lower odds of OMT
- OR 0.74, 95% CI 0.60-0.90
- Private insurance: higher odds of OMT
- OR 1.93, 95% CI 1.32-2.84
- Coronary disease: higher odds of OMT
- OR 1.62, 95% CI 1.01-2.61
- Median odds ratio, indicating moderate variability in OMT use independent of patient factors
- 1.82 (95% CI 1.03-7.32)
Original publication
Use of optimal medical therapy in patients with diabetes and atherosclerotic cardiovascular disease: Insights from a prospective longitudinal cohort study. Diabetes Obes Metab. Published 7 March 2023. doi:10.
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