Dyslipidemia Treatment and Lipid Control in US Adults with Diabetes by Sociodemographic and Cardiovascular Risk Groups in the NIH Precision Medicine Initiative All of Us Research Program

Abstract

Real-world data on lipid levels and treatment among adults with diabetes mellitus (DM) are relatively limited. We studied lipid levels and treatment status in patients with DM across cardiovascular disease (CVD) risk groups and sociodemographic factors. In the All of Us Research Program, we categorized DM as (1) moderate risk (≤1 CVD risk factor), (2) high risk (≥2 CVD risk factors), and (3) DM with atherosclerotic CVD (ASCVD). We examined the use of statin and non-statin therapy as well as LDL-C and triglyceride levels. We studied 81,332 participants with DM, which included 22.3% non-Hispanic Black and 17.2% Hispanic. A total of 31.1% had ≤1 DM risk factor, 30.3% had ≥2 DM risk factors, and 38.6% of participants had DM with ASCVD. Only 18.2% of those with DM and ASCVD were on high-intensity statins. Overall, 5.1% were using ezetimibe and 0.6% PCSK9 inhibitors. Among those with DM and ASCVD, only 21.1% had LDL-C < 70 mg/dL. Overall, 1.9% of participants with triglycerides ≥ 150 mg/dL were on icosapent ethyl. Those with DM and ASCVD were more likely to be on high-intensity statins, ezetimibe, and icosapent ethyl. Guideline-recommended use of high-intensity statins and non-statin therapy among our higher risk DM patients is lacking, with LDL-C inadequately controlled.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…Among 81 332 participants with diabetes in the All of Us Program, 49.8% were not on statin therapy. 70 Only 18.2% of those with diabetes and ASCVD were on high-intensity statins. Overall, 5.1% were using ezetimibe and 0.6% were using PCSK9 inhibitors.…”

Correction: Akbarpour et al. Dyslipidemia Treatment and Lipid Control in US Adults with Diabetes by Sociodemographic and Cardiovascular Risk Groups in the NIH Precision Medicine Initiative All of Us Research Program. J. Clin. Med. 2023, 12, 1668

“…In the original publication [1], there was a mistake in reporting in Tables 2 and 3 a few cells with very small percentages, which imply sample sizes of <20 which was an unintentional violation of the All of Us policy to do so. The corrected Tables 2 and 3 appear below, indicating dashes in the cells where this was the case.…”

Icosapent Ethyl and Atherosclerotic Cardiovascular Disease in Type 2 Diabetes (Narrative Review)

“…However, there is accumulating evidence that lipid-lowering treatment contributes to long-term glucose homeostasis alterations and T2D [4]. Due to increased triglyceride (TG) levels, despite reaching target levels of low-density lipoprotein cholesterol (LDL-C), patients nevertheless may have a risk of ASCVD [5,6]. Patients with persistently elevated fasting TG (>2.26 mmol/L) and maximally tolerated statin therapy may benefit from fibrates or ω-3 polyunsaturated fatty acids (ω-3 PUFAs) for additional LDL-C lowering.…”