Abstract 15727

Background: After a cardiovascular event, ACC/AHA guidelines suggest a high intensity statin for most patients to achieve ≥50% reduction in LDL-C. However, it is not known how often clinicians assess the effectiveness of statin treatment in achieving this goal in practice.

Methods: LDL-C measurements were obtained in 7,414 Olmsted County, MN residents (2005-2012) with diabetes mellitus (DM) alone (n=4503), ASCVD (defined as myocardial infarction, unstable angina, revascularization, or ischemic stroke/transient ischemic attack) alone (n=2343), and ASCVD with concomitant DM (n=568) in time windows after diagnosis (0-6, >6-12, >12-18,>18-24 months).

Results: In the first 2 years of follow-up, 41.3%, 25.7%, and 19.0% of patients with DM alone, ASCVD alone, and ASCVD+DM, respectively, were never prescribed a statin. Over median follow-up of 5.6 years (maximum 10.7 years), rates of LDL-C measurements per 10 person-years were 4.21, 8.33, and 9.82, respectively, and 11.7%, 12.8%, and 11.1% of patients, respectively, had no LDL-C measurements during follow-up. In the first 6 months after diagnosis, LDL-C measurements were more frequent in those with ASCVD alone or ASCVD+DM compared with DM alone. Thereafter, the distribution was similar although the mean number of measurements was higher in the ASCVD+DM group. The proportion of LDL-C measurements <70 mg/dL were 14.1%. 32.4% and 44.1% for DM alone, ASCVD alone and ASCVD+DM, respectively. Mean LDL-C values differed between all 3 groups (p<0.001) in every time window, with the highest levels observed among those with DM alone.

Conclusions: Despite the presence of quality measures, the majority of LDL-C measurements above goal, and risk of subsequent events among patients with ASCVD or DM, relatively few LDL-C measurements were taken after the initial diagnosis, especially in patients with DM. Further study is needed to understand reasons for lack of periodic assessment of lipid-lowering treatment effectiveness.