Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registry
Objective: Lowering lipid to reach guideline-indicated goals significantly reduces cardiovascular outcomes in very-high-risk (VHR) patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes (DM2). How well VHR patients currently achieve these goals in community practice is unkn...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-03-01
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| Series: | American Journal of Preventive Cardiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667724002903 |
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| author | Satoshi Shoji Nishant P. Shah Peter Shrader Laine E. Thomas Jonathan D. Arnold Nafeesa N. Dhalwani Neena A. Thomas Bethany Kalich Elisa L. Priest Mahanaz Syed Cezary Wójcik Eric D. Peterson Ann Marie Navar |
| author_facet | Satoshi Shoji Nishant P. Shah Peter Shrader Laine E. Thomas Jonathan D. Arnold Nafeesa N. Dhalwani Neena A. Thomas Bethany Kalich Elisa L. Priest Mahanaz Syed Cezary Wójcik Eric D. Peterson Ann Marie Navar |
| author_sort | Satoshi Shoji |
| collection | DOAJ |
| description | Objective: Lowering lipid to reach guideline-indicated goals significantly reduces cardiovascular outcomes in very-high-risk (VHR) patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes (DM2). How well VHR patients currently achieve these goals in community practice is unknown. Methods: VHR patients with ASCVD and DM2 were identified across 14 US healthcare systems using electronic health records between 1/1/2021–12/31/2022. Achievement of guideline-based lipid goals was determined according to the 2018 AHA/ACC/Multisociety guideline, defined as either having a low-density lipoprotein-cholesterol <70 mg/dL or receiving maximal lipid-lowering therapy (i.e., on a PCSK9i monoclonal antibody). Multivariable logistic regression was used to evaluate factors associated with the achievement of these goals. Results: Among 213,380 eligible patients (median age 71.0 years, 42 % women), 51.8 % achieved guideline-based lipid goals. Female sex (odds ratio [OR], 0.64; 95 % confidence interval [CI], 0.61–0.66), Black race (OR, 0.67; 95 % CI, 0.63–0.72 vs white race), and those on Medicaid (OR, 0.92; 95 % CI, 0.86–0.97 vs Medicare) were associated with a lower likelihood of achieving guideline-based lipid goals. Overall, 76.0 % of patients were on statin, 40.5 % were on a high-intensity statin and only 5.8 % were on a statin in combination with ezetimibe or a PCSK9i monoclonal antibody. Conclusion: Almost half of all VHR patients with ASCVD and DM2 do not achieve current guideline lipid goals. Women, Black individuals, and those on Medicaid were significantly less likely to achieve these goals relative to their counterparts. Further targeted quality improvement interventions are needed to improve the equitable achievement of guideline-based lipid goals. |
| format | Article |
| id | doaj-art-aa0a5450e1a740b3b0ad8d985b6e1c7b |
| institution | Kabale University |
| issn | 2666-6677 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj-art-aa0a5450e1a740b3b0ad8d985b6e1c7b2025-01-11T06:42:04ZengElsevierAmerican Journal of Preventive Cardiology2666-66772025-03-0121100921Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registrySatoshi Shoji0Nishant P. Shah1Peter Shrader2Laine E. Thomas3Jonathan D. Arnold4Nafeesa N. Dhalwani5Neena A. Thomas6Bethany Kalich7Elisa L. Priest8Mahanaz Syed9Cezary Wójcik10Eric D. Peterson11Ann Marie Navar12Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology and Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Corresponding author at: Duke Clinical Research, Institute, 300 W Morgan St, Durham, NC 27701, USA.Division of Cardiology and Department of Medicine, Duke University School of Medicine, Durham, NC, USADuke Clinical Research Institute, Durham, NC, USADepartment of Biostatistics and Bioinformatics, Duke University School of Medicine, NC, USADepartment of Medicine, University of Pittsburgh School of Medicine, PA, USAAmgen Inc, USACenter for Biostatistics, The Ohio State University, OH, USAAmgen Inc, USABaylor Scott & White Research Institute, TX, USADepartment of Population Health Sciences, University of Texas Health Science Center San Antonio, TX, USAAmgen Inc, USAUT Southwestern Medical Center, Department of Medicine, Division of Cardiology, TX, USAUT Southwestern Medical Center, Department of Medicine, Division of Cardiology, TX, USAObjective: Lowering lipid to reach guideline-indicated goals significantly reduces cardiovascular outcomes in very-high-risk (VHR) patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes (DM2). How well VHR patients currently achieve these goals in community practice is unknown. Methods: VHR patients with ASCVD and DM2 were identified across 14 US healthcare systems using electronic health records between 1/1/2021–12/31/2022. Achievement of guideline-based lipid goals was determined according to the 2018 AHA/ACC/Multisociety guideline, defined as either having a low-density lipoprotein-cholesterol <70 mg/dL or receiving maximal lipid-lowering therapy (i.e., on a PCSK9i monoclonal antibody). Multivariable logistic regression was used to evaluate factors associated with the achievement of these goals. Results: Among 213,380 eligible patients (median age 71.0 years, 42 % women), 51.8 % achieved guideline-based lipid goals. Female sex (odds ratio [OR], 0.64; 95 % confidence interval [CI], 0.61–0.66), Black race (OR, 0.67; 95 % CI, 0.63–0.72 vs white race), and those on Medicaid (OR, 0.92; 95 % CI, 0.86–0.97 vs Medicare) were associated with a lower likelihood of achieving guideline-based lipid goals. Overall, 76.0 % of patients were on statin, 40.5 % were on a high-intensity statin and only 5.8 % were on a statin in combination with ezetimibe or a PCSK9i monoclonal antibody. Conclusion: Almost half of all VHR patients with ASCVD and DM2 do not achieve current guideline lipid goals. Women, Black individuals, and those on Medicaid were significantly less likely to achieve these goals relative to their counterparts. Further targeted quality improvement interventions are needed to improve the equitable achievement of guideline-based lipid goals.http://www.sciencedirect.com/science/article/pii/S2666667724002903Atherosclerotic cardiovascular diseaseType 2 diabetesGuideline-based lipid goalsLipid-lowering therapyLow-density lipoprotein cholesterolVery-high risk |
| spellingShingle | Satoshi Shoji Nishant P. Shah Peter Shrader Laine E. Thomas Jonathan D. Arnold Nafeesa N. Dhalwani Neena A. Thomas Bethany Kalich Elisa L. Priest Mahanaz Syed Cezary Wójcik Eric D. Peterson Ann Marie Navar Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registry American Journal of Preventive Cardiology Atherosclerotic cardiovascular disease Type 2 diabetes Guideline-based lipid goals Lipid-lowering therapy Low-density lipoprotein cholesterol Very-high risk |
| title | Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registry |
| title_full | Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registry |
| title_fullStr | Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registry |
| title_full_unstemmed | Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registry |
| title_short | Achievement of guideline-based lipid goals among very-high-risk patients with atherosclerotic cardiovascular disease and type 2 diabetes: results in 213,380 individuals from the cvMOBIUS2 registry |
| title_sort | achievement of guideline based lipid goals among very high risk patients with atherosclerotic cardiovascular disease and type 2 diabetes results in 213 380 individuals from the cvmobius2 registry |
| topic | Atherosclerotic cardiovascular disease Type 2 diabetes Guideline-based lipid goals Lipid-lowering therapy Low-density lipoprotein cholesterol Very-high risk |
| url | http://www.sciencedirect.com/science/article/pii/S2666667724002903 |
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