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Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales

Daniel King, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Mathew Lawrence, Clive Weston Orcid Logo, Sam Rice, Chris Hopkins Orcid Logo, Leighton Phillips Orcid Logo, Julian Halcox Orcid Logo, Daniel Harris

European Heart Journal Open, Volume: 5, Issue: 6, Start page: oeaf158

Swansea University Authors: Daniel King, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo, Daniel Harris

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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...

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Published in: European Heart Journal Open
ISSN: 2752-4191
Published: Oxford University Press (OUP) 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa71038
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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&#x2013;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&#x2013;23), testing of LDL-C decreased from 70.3% to 67.1%, and of those with documented lipids 41.0% achieved an LDL-C &lt;1.8&#x2005;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 &gt;20%, only half were prescribed LLT. 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spelling 2026-01-20T11:18:36.7079670 v2 71038 2025-12-01 Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales e23c527859999beb492e07947eb380e5 Daniel King Daniel King true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false 2025-12-01 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. Journal Article European Heart Journal Open 5 6 oeaf158 Oxford University Press (OUP) 2752-4191 Lipids, Cholesterol, Atherosclerosis, Statin, Pharmacoepidemiology 30 11 2025 2025-11-30 10.1093/ehjopen/oeaf158 COLLEGE NANME COLLEGE CODE Swansea University SU Library paid the OA fee (TA Institutional Deal) This study was funded by an unrestricted research grant from Amgen. 2026-01-20T11:18:36.7079670 2025-12-01T13:43:52.6455928 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Daniel King 1 Ashley Akbari 0000-0003-0814-0801 2 Michael Gravenor 0000-0003-0710-0947 3 Mathew Lawrence 4 Clive Weston 0000-0002-8995-8199 5 Sam Rice 6 Chris Hopkins 0000-0003-2496-3832 7 Leighton Phillips 0000-0003-4918-8174 8 Julian Halcox 0000-0001-6926-2947 9 Daniel Harris 10 71038__36054__a10e14cc336c4cfbbd21cd6680d60725.pdf 71038.VOR.pdf 2026-01-20T11:14:58.2403411 Output 1004932 application/pdf Version of Record true © 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. true eng https://creativecommons.org/licenses/by/4.0/
title Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales
spellingShingle Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales
Daniel King
Ashley Akbari
Michael Gravenor
Julian Halcox
Daniel Harris
title_short Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales
title_full Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales
title_fullStr Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales
title_full_unstemmed Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales
title_sort Management of atherosclerotic cardiovascular disease risk in diabetes mellitus patients: a population-level observational cohort study in Wales
author_id_str_mv e23c527859999beb492e07947eb380e5
aa1b025ec0243f708bb5eb0a93d6fb52
70a544476ce62ba78502ce463c2500d6
3676f695eeda169d0f8c618adf27c04b
e60c9c73b645f0e8033ae26fa8e634b8
author_id_fullname_str_mv e23c527859999beb492e07947eb380e5_***_Daniel King
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
author Daniel King
Ashley Akbari
Michael Gravenor
Julian Halcox
Daniel Harris
author2 Daniel King
Ashley Akbari
Michael Gravenor
Mathew Lawrence
Clive Weston
Sam Rice
Chris Hopkins
Leighton Phillips
Julian Halcox
Daniel Harris
format Journal article
container_title European Heart Journal Open
container_volume 5
container_issue 6
container_start_page oeaf158
publishDate 2025
institution Swansea University
issn 2752-4191
doi_str_mv 10.1093/ehjopen/oeaf158
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description 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.
published_date 2025-11-30T05:34:24Z
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