{"doi":"10.1001/jamanetworkopen.2021.48030","title":"Use of Lipid-, Blood Pressure–, and Glucose-Lowering Pharmacotherapy in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease","abstract":"Importance: Based on contemporary estimates in the US, evidence-based therapies for cardiovascular risk reduction are generally underused among patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). Objective: To determine the use of evidence-based cardiovascular preventive therapies in a broad US population with diabetes and ASCVD. Design, Setting, and Participants: This multicenter cohort study used health system-level aggregated data within the National Patient-Centered Clinical Research Network, including 12 health systems. Participants included patients with diabetes and established ASCVD (ie, coronary artery disease, cerebrovascular disease, and peripheral artery disease) between January 1 and December 31, 2018. Data were analyzed from September 2020 until January 2021. Exposures: One or more health care encounters in 2018. Main Outcomes and Measures: Patient characteristics by prescription of any of the following key evidence-based therapies: high-intensity statin, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) and sodium glucose cotransporter-2 inhibitors (SGLT2I) or glucagon-like peptide-1 receptor agonist (GLP-1RA). Results: The overall cohort included 324 706 patients, with a mean (SD) age of 68.1 (12.2) years and 144 169 (44.4%) women and 180 537 (55.6%) men. A total of 59 124 patients (18.2% ) were Black, and 41 470 patients (12.8%) were Latinx. Among 205 885 patients with specialized visit data from the prior year, 17 971 patients (8.7%) visited an endocrinologist, 54 330 patients (26.4%) visited a cardiologist, and 154 078 patients (74.8%) visited a primary care physician. Overall, 190 277 patients (58.6%) were prescribed a statin, but only 88 426 patients (26.8%) were prescribed a high-intensity statin; 147 762 patients (45.5%) were prescribed an ACEI or ARB, 12 724 patients (3.9%) were prescribed a GLP-1RA, and 8989 patients (2.8%) were prescribed an SGLT2I. Overall, 14 918 patients (4.6%) were prescribed all 3 classes of therapies, and 138 173 patients (42.6%) were prescribed none. Patients who were prescribed a high-intensity statin were more likely to be men (59.9% [95% CI, 59.6%-60.3%] of patients vs 55.6% [95% CI, 55.4%-55.8%] of patients), have coronary atherosclerotic disease (79.9% [95% CI, 79.7%-80.2%] of patients vs 73.0% [95% CI, 72.8%-73.3%] of patients) and more likely to have seen a cardiologist (40.0% [95% CI, 39.6%-40.4%] of patients vs 26.4% [95% CI, 26.2%-26.6%] of patients). Conclusions and Relevance: In this large cohort of US patients with diabetes and ASCVD, fewer than 1 in 20 patients were prescribed all 3 evidence-based therapies, defined as a high-intensity statin, either an ACEI or ARB, and either an SGLT2I and/or a GLP-1RA. These findings suggest that multifaceted interventions are needed to overcome barriers to the implementation of evidence-based therapies and facilitate their optimal use.","journal":"JAMA Network Open","year":2022,"id":235891,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":74,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9622,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":337848,"name":"Emily C. O’Brien","orcid":"0000-0002-8257-7561","position":1,"is_corresponding":false},{"id":629535,"name":"Lisa A. Kaltenbach","orcid":null,"position":2,"is_corresponding":false},{"id":276834,"name":"Jennifer B. Green","orcid":"0000-0002-9967-5352","position":3,"is_corresponding":false},{"id":55170,"name":"Renato D. Lópes","orcid":"0000-0003-2999-4961","position":4,"is_corresponding":false},{"id":503541,"name":"Caryn G. Morse","orcid":"0000-0002-1177-4365","position":5,"is_corresponding":false},{"id":55172,"name":"Hussein R. Al‐Khalidi","orcid":"0000-0003-1375-0487","position":6,"is_corresponding":false},{"id":298021,"name":"Vanita R. Aroda","orcid":"0000-0002-7706-4585","position":7,"is_corresponding":false},{"id":269852,"name":"Matthew A. Cavender","orcid":"0000-0002-4466-4760","position":8,"is_corresponding":false},{"id":855631,"name":"Tanya Gaynor","orcid":null,"position":9,"is_corresponding":false},{"id":854952,"name":"Julienne K. Kirk","orcid":"0000-0002-5144-7780","position":10,"is_corresponding":false},{"id":231195,"name":"Ildiko Lingvay","orcid":"0000-0001-7006-7401","position":11,"is_corresponding":false},{"id":854953,"name":"Melissa Magwire","orcid":"0000-0002-9118-5834","position":12,"is_corresponding":false},{"id":74977,"name":"Darren K. McGuire","orcid":"0000-0002-6412-7989","position":13,"is_corresponding":false},{"id":855632,"name":"Jonathan Pak","orcid":null,"position":14,"is_corresponding":false},{"id":231193,"name":"Rodica Pop‐Busui","orcid":"0000-0002-2042-1350","position":15,"is_corresponding":false},{"id":832831,"name":"Caroline R. Richardson","orcid":"0000-0002-1945-6046","position":16,"is_corresponding":false},{"id":855633,"name":"Çağrı Şenyücel","orcid":null,"position":17,"is_corresponding":false},{"id":706689,"name":"Michelle D. Kelsey","orcid":"0000-0002-2169-043X","position":18,"is_corresponding":false},{"id":271439,"name":"Neha J. Pagidipati","orcid":"0000-0002-5004-8868","position":19,"is_corresponding":false},{"id":260564,"name":"Christopher B. Granger","orcid":"0000-0002-0045-3291","position":20,"is_corresponding":false},{"id":522140,"name":"Adam J. Nelson","orcid":"0000-0003-0990-2548","position":0,"is_corresponding":true}],"reference_count":53,"raw_metadata":null,"created_at":"2026-07-19T00:21:53.333008Z","pmid":"35175345","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}