Association of Strict Versus Lenient Cholesterol Lowering with Cardiac Outcomes, Diabetes Progression and Complications, and Mortality in Patients with Diabetes Treated with Statins: Is Less More?

Victoria Odeleye, Omar Masarweh, Jorge Restrepo, Carlos A Alvarez and Ishak A. Mansi ()
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Victoria Odeleye: University of Central Florida HCA Healthcare GME
Omar Masarweh: University of Central Florida HCA Healthcare GME
Jorge Restrepo: University of Central Florida College of Medicine
Carlos A Alvarez: Texas Tech University Health Sciences Center
Ishak A. Mansi: University of Central Florida College of Medicine

Drug Safety, 2023, vol. 46, issue 11, No 4, 1105-1116

Abstract: Abstract Introduction Whereas some guidelines recommend statin use to achieve low-density lipoprotein cholesterol (LDL-C) goal 70 to100 mg/dL) LDL-C lowering on major adverse cardiovascular events (MACE), diabetes progression, diabetes microvascular complications, and total mortality in patients with diabetes. Methods This was a retrospective propensity score (PS)-matched study from a national cohort of, predominantly male, veterans diagnosed with diabetes without prior cardiovascular disease (from fiscal years 2003–2015), who were initiated on a statin. We created PS to match strict (mean LDL-C during follow-up ≤ 70 mg/dL) versus lenient (mean LDL-C during follow up > 70–100 mg/dL) using 65 baseline characteristics including comorbidities, risk scores, medication classes usage, vital signs, and laboratory data. Outcomes included MACE, diabetes progression, microvascular diabetes complications, and total mortality. Results From 80,110 eligible patients, we PS-matched 21,294 pairs of statin initiators with strict or lenient LDL-C lowering. The mean (SD) age was 64 (9.5) years and mean (SD) duration of follow-up was 6 (3) years. MACE was similar in the PS-matched groups [6.1% in strict versus 5.8% in lenient; odds ratio (OR): 1.06; 95% confidence interval (95% CI) 0.98–1.15, P = 0.17]. Diabetes progression was higher among the strict vs lenient group (66.7% in strict versus 64.1% in lenient; OR 1.12; 95% CI 1.08–1.17, P

Date: 2023
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DOI: 10.1007/s40264-023-01347-8

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