Suboptimal Use of Secondary Prevention Therapies in Atherosclerotic CVD

atherosclerosis, CAD, coronary artery disease, plaque
atherosclerosis, CAD, coronary artery disease, plaque
Glucose-lowering medications and high-intensity statins are not being used sufficiently among high-risk individuals with atherosclerotic cardiovascular disease and diabetes.

According to a study recently published in Circulation, secondary prevention therapies, particularly glucose-lowering medications and high-intensity statins, are not being used sufficiently among high-risk individuals with atherosclerotic cardiovascular disease (ASCVD) and diabetes.

This study included 5006 participants with ASCVD, 34.7% (n=1735) of whom had diabetes. The mean age of those with diabetes was 67.5 years, and 59.9% were men. A prior myocardial infarction was reported in 33.3% of the participants. All were either receiving a proprotein convertase subtilsin-kexin type 9 inhibitor or had low-density lipoprotein levels ≥70 mg/dL. Baseline comorbidities, medications, demographic characteristics, and laboratory data were used for this study.

The use of effective secondary prevention therapies was optimal in only 6.9% of participants, with cardiologists delivering lower rates of optimal care (5.6%) than noncardiologists (8.0%; P =.057). Despite an 87.8% rate of statin therapy and similar antiplatelet/anticoagulant rates, just 45.4% of the participants were treated with high-intensity statins and 9.7% were treated with ezetimibe. Fewer than 20% were given glucose-lowering medications, and very few were treated with a guideline-recommended combination. The uptake of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors among those with type 2 diabetes and ASCVD has only marginally increased from the low figures recorded between 2013 and 2016.

A limitation of this study was a lack of accounting for contraindications, intolerance, and other barriers to successful therapy.

The investigators concluded that “we found suboptimal rates of use of secondary prevention therapies in high-risk patients with diabetes and ASCVD, particularly with high-intensity statins and glucose-lowering therapies with proven cardiovascular benefit. Given the high cardiovascular event rates…in this patient population, improving use of these guideline recommended therapies is an important potential opportunity to improve care and, in turn, reduce the risk of recurrent ASCVD events, heart failure hospitalizations, and cardiovascular mortality.”

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This study was funded by Amgen. The study investigators report numerous associations with pharmaceutical companies.


Arnold SV, de Lemos JA, Rosenson RS, et al. Use of guideline-recommended risk-reduction strategies among patients with diabetes and atherosclerotic cardiovascular disease: insights from Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) [published online June 7, 2019]. Circulation. doi:10.1161/CIRCULATIONAHA.119.041730