Abstract 4371216: Lipid-Lowering Therapy Is Underutilized Across LDL-C Levels in Autoimmune Disease Compared to Diabetes: A Nationwide Analysis

Abstract

Background: It is well known that Autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus confer atherosclerotic cardiovascular disease (ASCVD) risk comparable to diabetes mellitus (DM). However, prescribing patterns of lipid-lowering therapy in this population remain underexplored. Hypothesis: Patients with autoimmune disease are less likely to receive statins and non-statin lipid-lowering therapy than those with DM across low-density-lipoprotein-cholesterol (LDL-C) strata. Methods: We conducted a nationwide retrospective cohort study using the TriNetX platform, which provides real-time, deidentified clinical data from electronic health records. Adults (≥18 years) with either rheumatoid arthritis or systemic lupus erythematosus or DM type 1 or 2 and at least one low-density lipoprotein cholesterol value were included. Patients were stratified into six LDL-C categories: <70, 70–99, 100–129, 130–159, 160–189, and ≥190 mg/dL. Initiation of lipid-lowering therapy within six months of cholesterol measurement was assessed. Statins included atorvastatin, rosuvastatin, simvastatin, pravastatin, lovastatin, fluvastatin, pitavastatin. Non-statin therapies included icosapent ethyl, colesevelam, alirocumab, evolocumab, Bempedoic acid, cholestyramine, Inclisiran, colestipol, ezetimibe, gemfibrozil, omega-3 acid, fenofibrate. Individuals with major ASCVD risk factors, prior major adverse cardiovascular events, known statin intolerance, or liver disease were excluded. Comparisons were made using chi-square tests with significance defined as p<0.05. Results: Among 41,805 patients with autoimmune disease and 427,909 with DM, statin use was significantly lower in the autoimmune group across all LDL-C categories: 23.65% vs 33.44% (<70 mg/dL), 17.65% vs 27.86% (70–99), 14.21% vs 25.41% (100–129), 17.20% vs 28.50% (130–159), 26.00% vs 35.59% (160–189), and 39.15% vs 44.91% (≥190) (all p<0.0001). Non-statin lipid-lowering therapy use was significantly lower in autoimmune patients compared to those with diabetes across all LDL-C tertiles, with the largest differences observed at LDL <70 mg/dL (6.19% vs 10.24%, p<0.0001) and 70–99 mg/dL (4.05% vs 7.06%, p<0.0001). Conclusion: Despite comparable ASCVD risk, patients with autoimmune disease are significantly less likely to receive statins or non-statin lipid-lowering therapy than those with DM across LDL-C levels. These findings show a need for improved cardiovascular prevention in this high-risk population.