(B-035) Use of lipid lowering therapies (LLTs) among adults by type 2 diabetes (T2D) diagnosis, with discordant apolipoprotein B (apoB) and LDL-cholesterol (LDL-C) values using US real-world data

Background: LLTs play a significant role in managing elevated levels of LDL-C and apoB, thereby reducing cardiovascular (CVD) risk. While LLTs are commonly used among patients with elevated LDL-C, usage among patients whose LDL-C and apoB are discordant is not well known.

Objectives: To examine use of LLTs among adults with discordant apoB/LDL-C values, overall and by T2D status.

Methods: This US-based, retrospective cohort study identified adults in the Veradigm Network EHR linked to closed claims from Komodo Health with an apoB and LDL-C lab result within 6 months of each other between 2013-2024 (earliest lab=index). Patients had EHR/claims activity ≥12 months pre- and ≥24 months post-index. Cohorts were stratified by no evidence of T2D during the study period and those with a baseline T2D diagnosis. Based on median apoB and LDL-C values, discordance categories were examined within cohorts. Demographics were assessed during baseline; and unadjusted clinical characteristics (including LLT use) and cardiovascular event frequencies were reported during follow-up. Logistic regression models examined risk of incident hypertension, controlling for baseline covariates including LLT use.

Results: A total of 21,891 adults were included, of which 4,504 (21%) were apoB/LDL-C discordant. Of them, 5,551 and 14,549 were included in the T2D and without T2D cohorts, and 21% and 20% were discordant, respectively. Overall, mean (SD) age was 56 (13), 53% were female, and 66% White. Use of LLTs at baseline was 43% overall, and 54% among discordant high-risk (high apoB/low LDL-C) and 30% among discordant low-risk (low apoB/high LDL-C). Statin were more commonly used (38%), followed by fibrates, dietary sources/soluble fiber (both 3.9%), omega-3 fatty acids and ezetimibe (both 3%). Use of PCSK9 was low ( < 1%), but highest among high-risk discordant patients with T2D (1.5%). During follow-up, LLT use increased to 59% overall, with the highest proportion of use among discordant high-risk T2D patients (88%), followed by overall discordant high-risk (72%), and discordant low-risk T2D cohort (70%). Among discordant high-risk patients without T2D, 39% had no evidence of LLTs despite having mean (SD) apoB of 106 (17) mg/dL and 50% baseline rate of CVD. Adjusted models trended toward higher odds of incident hypertension among patients who were discordant high-risk.

Conclusions: With recent clinical guidelines recognizing the importance of apoB in CVD risk assessment, these findings highlight a subset of the population with an elevated apoB, but low LDL-C who are not currently receiving LLTs, potentially due to the discordance in lipid values. These findings may not be generalizable to patients without insurance coverage or not engaged in care.