Low Statin Persistence Over 36-months is a High-Risk Marker in Adults with Diabetes
Bibliographic record
Abstract
Statin therapy prevents cardiovascular disease (CVD) in adults with diabetes. There is on-going inconsistency between clinical practice guidelines on whether specific LDL-C levels should be targeted in those on statin therapy. Additionally, real world persistence with statin therapy appears to have plateaued. To examine the real-world effects of statin use and persistence, and LDL-C levels, on CVD risk, we performed a retrospective cohort study using Alberta administrative health data. We included adults with diabetes and no previous history of CVD, who were 50 years old on April 1, 2012, and followed them until March 31, 2019 for a primary composite outcome of MI, stroke, and revascularization. Statin persistence was defined as the number of 6-month periods in the preceding 3 years during which there were one or more statin dispensations with the first documented window of statin use between April 1, 2009 to September 30, 2009. LDL-C levels (categorized as or > 2.0 mmol/L) were obtained from linked laboratory results. We conducted a time-varying Cox proportional hazards regression with adjustment for age, sex, income, intensity of diabetes therapy, and other comorbidities. We included 72,541 individuals (mean age = 65.4 (SD 8.9), 47.6% female). The overall primary outcome rate was 10.4 per 1,000 person-years. Independent of statin use and other variables, LDL-C 2.0 mmol/L was strongly associated with reduced CVD (adjusted hazard ratio [HR] 0.64 [95% Confidence Interval (CI) 0.59–0.69], p <0.001). A high degree of statin persistence, i.e.: statin use in 5 or more of the preceding six-month periods over the previous 3 years was associated with reduced cardiovascular (CV) risk (HR 0.79, [0.71–0.86], p <0.001), compared to those with no statin use in the preceding 3 years. Low statin persistence (statin persistence level (SPL) 1-2 of 6) was associated with higher primary outcome risk compared to statin non-users (HR 1.34 [1.19–1.51], p <0.001). Moderate statin persistence (SPL 3-4 of 6) showed no association with the primary outcome compared to statin non-users (HR 1.00 [0.88–1.15], p = 0.959) In adults with diabetes and no previous CVD, statin use in at least 5 of the preceding six-month periods over the previous 3 years appears necessary to yield the proven CVD reducing benefits of statin therapy. Individuals with LDL-C > 2.0 mmol/L and documented statin use in only 1-2 six-month periods in the preceding 3 years are at elevated CVD risk, and may benefit from recall for additional CVD risk reduction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".