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Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales
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Michael Gravenor ,
Mathew Lawrence,
Clive Weston ,
Sam Rice,
Chris Hopkins ,
Leighton Phillips ,
Julian Halcox ,
Daniel Harris
European Heart Journal Open, Volume: 5, Issue: 6, Start page: oeaf158
Swansea University Authors:
Daniel King, Ashley Akbari , Michael Gravenor , Julian Halcox , Daniel Harris
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© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License.
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DOI (Published version): 10.1093/ehjopen/oeaf158
Abstract
Aims: In patients with diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD), or without ASCVD (primary prevention), the prescribing of lipid lowering therapy (LLT) is an established treatment strategy endorsed by clinical guidelines. This study aimed to document (i) trends in pr...
| Published in: | European Heart Journal Open |
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| ISSN: | 2752-4191 |
| Published: |
Oxford University Press (OUP)
2025
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa71038 |
| Abstract: |
Aims: In patients with diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD), or without ASCVD (primary prevention), the prescribing of lipid lowering therapy (LLT) is an established treatment strategy endorsed by clinical guidelines. This study aimed to document (i) trends in presentation of DM, (ii) treatment, monitoring and achievement of target low-density lipoprotein cholesterol (LDL-C) in DM with ASCVD, and (iii) ASCVD risk assessment and lipid treatment according to risk in the DM primary prevention setting. Methods and results: A retrospective observational population study including 282 581 DM patients using linked health-care data (2010–23) in Wales. The prevalence of DM (documented DM diagnosis in record prior to the beginning of the year) increased from 133 439 in 2010 to 183 948 in 2023 (6504 to 8200 per 100 000), along with increasing incidence (new diagnosis of DM documented in record during specific year) with 11 074 cases in 2010 (540 per 100 000 per year), increasing to 14 539 in 2023 (648 per 100 000 per year). The proportion of prevalent patients with established ASCVD prescribed LLT decreased from 87.5% to 81.8% (2010–23), testing of LDL-C decreased from 70.3% to 67.1%, and of those with documented lipids 41.0% achieved an LDL-C <1.8 mmol/L in 2010 increasing to 52.2% in 2023. Amongst DM without ASCVD, the proportion prescribed LLT decreased from 78.9% to 54.9% in those with chronic kidney disease (CKD) and from 70.7% to 55.6% in those without CKD. Considering DM without ASCVD or CKD (LLT is recommended according to 10-year CVD risk), only 44.2% of incident DM had a documented QRISK score in 2022 and of those with a 10-year risk >20%, only half were prescribed LLT. Conclusion: Increasing incidence and prevalence of DM, together with decreasing quality of risk factor management has the potential to lead to poorer health outcomes in the population if not addressed more effectively. |
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| Keywords: |
Lipids, Cholesterol, Atherosclerosis, Statin, Pharmacoepidemiology |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
This study was funded by an unrestricted research grant from Amgen. |
| Issue: |
6 |
| Start Page: |
oeaf158 |