Trends and disparities in statin use and low-density lipoprotein cholesterol levels among US patients with diabetes, 1999–2014

Aims: The 2013 American College of Cardiology/American Heart Association Guideline defined patients with diabetes aged 40–75 years as a major statin benefit group. We explored the temporal trends and disparities in statin utilization and LDL-C levels among patients with diabetes aged 40–75 years. Methods: A total of 4860 patients from the National Health and Nutrition Examination Survey 1999 to 2014 were included in this study. Differences in statin use and LDL-C levels were explored by patient characteristics. Results: From 1999–2002 to 2011–2014, the prevalence of statin use increased from 26.2% to 49.5% (P_trend < 0.001). This was accompanied by a continuous decrease in the mean LDL-C level (from 115.8 mg/dL to 103.3 mg/dL, P_trend < 0.001). The use of guideline-defined high-potency statin medications (atorvastatin and rosuvastatin) remained largely unchanged (from 14.0% to 17.9%, P_trend = 0.55). Statin utilization increased with age. Women and blacks were 10% and 16% less likely to receive statin treatment compared with men and whites, respectively. In comparison with other statin treatment, use of atorvastatin or rosuvastatin was associated with average LDL-C reduction of 8.0 mg/dL. LDL-C levels were significantly higher among women and black patients. After adjustment for potential confounders, age and Hispanic-white differences in statin use and LDL-C levels were substantially attenuated. Conclusions: Despite a steady increase in statin use during the 16-year study period, statin therapy remains underutilized in certain subgroups of patients. Confounding factors related to healthcare utilization account for some of the disparities in statin use and LDL-C levels.