PATIENTS with diabetes face a markedly increased risk of cardiovascular events, yet many delay or decline statin therapy despite clinical recommendations. Understanding the consequences of postponing statin treatment is crucial, given its role in lowering cardiovascular risk. A recent retrospective cohort study conducted within the Mass General Brigham integrated health system examined the impact of delaying statin therapy on cardiovascular outcomes in adults with diabetes, revealing that deferral significantly increases the risk of myocardial infarction and ischemic stroke.
The study included 7,239 adults diagnosed with diabetes but without pre-existing atherosclerotic cardiovascular disease, observed between 2000 and 2018. Researchers compared patients who accepted statin therapy immediately upon recommendation with those who delayed initiation. The primary outcome measured was the combined incidence of myocardial infarction and ischemic stroke. Data were adjusted for demographic factors and comorbidities to isolate the effect of statin therapy timing on cardiovascular risk.
Results showed that 17.7% (1,280) of patients delayed starting statin treatment by an average of 2.7 years. During the delay period, these patients had significantly higher low-density lipoprotein (LDL) cholesterol levels (126.4 mg/dL versus 99.2 mg/dL, p<0.001) compared to those who commenced therapy immediately. Over 10 years, the cumulative rate of myocardial infarction and ischemic stroke was 8.5% among those who delayed treatment versus 6.4% in patients who began statins promptly (p=0.001). After adjusting for confounders, delayed acceptance of statins was independently associated with a 49% increased risk of cardiovascular events (hazard ratio: 1.49; 95% CI: 1.16–1.90; p=0.002). Mediation analysis further highlighted that elevated LDL cholesterol partly explained this increased risk.
These findings emphasise the critical importance of timely statin therapy in patients with diabetes to reduce cardiovascular risk. Clinicians should prioritise early intervention and address patient hesitancy towards statin initiation. However, as a retrospective study from a single health system, generalisability may be limited, and unmeasured factors could influence outcomes. Further prospective studies are needed to confirm these results and develop strategies to improve statin uptake. Nonetheless, the evidence supports proactive lipid-lowering treatment as a vital component of clinical management in diabetes care.
Reference
Shah N et al. Impact of Statin Nonacceptance on Cardiovascular Outcomes in Patients With Diabetes. J Am Heart Assoc. 2025;DOI: 10.1161/JAHA.124.040464.
