Timely Initiation of Statin Therapy for Diabetes Shown to Dramatically Reduce Risk of Heart Attack and Stroke

Mass General Brigham observational study of over 7,000 patients with diabetes showed those who started statin therapy immediately cut the risk of a cardiovascular event by a third compared to those who opted to delay statin treatment

Taking a statin medication is an effective, safe, and low-cost way to lower cholesterol and reduce risk of cardiovascular events. Despite clinicians recommending that many patients with diabetes take statins, nearly one-fifth of them opt to delay treatment. In a new study, researchers from Mass General Brigham found that patients who started statin therapy right away reduced the rate of heart attack and stroke by one third compared to those who chose to delay taking the medication. The results, which can help guide decision-making conversations between clinicians and their patients, are published in the Journal of the American Heart Association.

“I see patients with diabetes on a regular basis, and I recommend statin therapy to everyone who is eligible,” said senior author Alexander Turchin, MD, MS, of the Division of Endocrinology at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “Some people refuse because they want to first try lifestyle interventions or other drugs. But other interventions are not as effective at lowering cholesterol as starting statin therapy as soon as possible. Time is of the essence for your heart and brain health.”

Heart attacks and strokes remain the leading cause of complications and mortality for patients with diabetes. Statin therapy reduces risk of these cardiovascular events by preventing plaque buildup in the blood vessels, which, once accumulated, prevents delivery of oxygen and essential nutrients to the heart and brain.

The researchers used an artificial intelligence method called Natural Language Processing to gather data from the electronic health records of 7,239 patients at Mass General Brigham who ultimately started statin therapy during the nearly 20-year study period. The median patient age was 55, with 51% being women, 57% white, and the median HbA1c—a measure of blood sugar—being 6.9.

Nearly one-fifth (17.7%) of the patients in the study declined statin therapy when it was first recommended by their clinicians, then later accepted the therapy (after a median of 1.5 years) upon repeated recommendation by their clinician. Of those who delayed, 8.5% had a heart attack or stroke. But for patients who started statins immediately, the rate of those cardiovascular events was just 6.4%.

“Clinicians should recognize the increased cardiovascular risk associated with delaying statin therapy for patients with diabetes and use this information to guide shared decision-making conversations with their patients,” said Turchin.

Authorship: In addition to Turchin, Mass General Brigham authors include Zhou Lan. Other authors include Nisarg Shah, C. Justin Brown, and Seth S. Martin.

Disclosures: Martin reported personal consulting fees from Amgen, AstraZeneca, BMS, Chroma, Kaneka, Merck, New Amsterdam, Novartis, Novo Nordisk, Premier, and Sanofi, as well as grant support from Merck. Turchin reported receiving grants from Eli Lilly and personal fees from Novo Nordisk and Proteomics International.

Funding: This study was funded in part by the Patient-Centered Outcomes Research Institute (contract ME-2019C1-15328).

Paper cited: Shah, N et al. “Impact of Statin Non-Acceptance on Cardiovascular Outcomes in Patients with Diabetes” Journal of the American Heart Association DOI: 10.1161/JAHA.124.040464