Use of evidence-based cardiovascular preventive therapies in type 2 diabetes patients with established or high risk of atherosclerotic cardiovascular disease in China: A retrospective cohort study

Aims To examine trends of glucose-, blood pressure-, and lipid-lowering drugs and antiplatelet medications with cardiovascular benefit in type 2 diabetes (T2DM) patients with established or high risk of atherosclerotic cardiovascular disease (ASCVD). Materials and methods In this retrospective cohort study, we identified T2DM patients with established or high risk of ASCVD using diagnostic codes from the institutional data of Xiamen Humanity Hospital between 2018 and 2023. The prescription of any of the glucagon-like peptide-1 receptor agonist (GLP-1 RA) or sodium glucose cotransporter-2 inhibitors (SGLT2i), angiotensin-converting enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB), moderate-intensity statins, and aspirin was quantified using frequencies/percentages. Results We identified 17,320 patients with T2DM and established or high risk of ASCVD, with a mean of 66.3 years and 43.9% of patients were women. From 2018 to 2023, the use of GLP-1 RA increased from 2.7% to 13.7%; SGLT2i increased from 3.9% to 16.5%; ACEI/ARB increased from 28.1% to 43.0%; moderate-intensity statins increased from 61.6% to 70.5%; and aspirin increased from 23.7% to 32.9%. Overall, only 4.8% of patients were prescribed 4 evidence-based cardiovascular preventive therapies, and 17.6% of patients were not prescribed any of these medications. Conclusions This study demonstrated that despite a modest annual increase in the use of evidence-based cardiovascular preventive medications among patients with T2DM and established or high risk of ASCVD, less than 1 in 20 patients received all 4 medications. To maximize the potential population benefit of these therapies, further efforts are necessary on many fronts.