Statin prescription rates for prevention of atherosclerotic cardiovascular disease in adults 40-75 years old with type 1 diabetes.

Only 43.2% of adults with T1D aged 40-75 years were prescribed guideline-recommended statin therapy.

• Retrospective cross-sectional study of 266 adults with T1D aged 40-75 years at an integrated health system between 2020 and 2024.
• 95% CI for statin prescribing rate: 0.37 to 0.49.
• Among those with a history of ASCVD, only 39.3% received a high-intensity statin.
• Guidelines recommend statin use for ASCVD prevention in all adults with diabetes between ages 40 and 75 years.

Less than half of patients with T1D achieved current LDL cholesterol targets.

• 47.7% (95% CI 0.42 to 0.54) of patients achieved the latest (post-2023) LDL cholesterol targets.
• 53.0% (95% CI 0.47 to 0.59) achieved LDL targets using pre-2023 targets.
• LDL cholesterol levels were extracted from medical records.

Female sex was independently associated with lower odds of receiving guideline-recommended statin therapy and lower odds of achieving LDL targets.

• Female sex was associated with lower odds of statin therapy: aOR 0.45 (95% CI 0.24 to 0.85, p=0.015) in multivariable analysis.
• Female sex was also associated with lower odds of achieving LDL targets: OR 0.43 (95% CI 0.28 to 0.64, p=0.046).
• These associations were identified through multivariable logistic regression analyses.

History of ASCVD was independently associated with higher odds of statin use.

• ASCVD history was associated with aOR 2.75 (95% CI 1.34 to 5.57, p=0.005) for statin use in multivariable analysis.
• Despite higher odds of any statin use, only 39.3% of those with ASCVD history received a high-intensity statin, indicating underprescribing even in secondary prevention.

The most common barriers to statin prescribing were deferral to another healthcare professional, statin intolerance, and clinical inertia.

• Deferral to another healthcare professional was the most common barrier, occurring in 23.3% of cases.
• Statin intolerance was documented in 15.8% of cases.
• Clinical inertia accounted for 9.0% of barriers.
• Barriers were identified via endocrine physician documentation in medical records.

Adjunctive lipid-lowering agents were very rarely prescribed in this population.

• Ezetimibe was prescribed to only 4.1% of patients.
• PCSK9 inhibitors were prescribed to only 0.4% of patients.
• No patients were on bempedoic acid.
• This represents a notable gap given guideline recommendations for adjunctive therapy in high-risk patients not achieving LDL targets.