Abstract Body (Do not enter title and authors here): 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.