299-OR: Relative Contribution of Statin Intensity, Low-Density Lipoprotein Cholesterol Level and Duration of Statin Therapy for Cardiovascular Risk Reduction in Patients with Type 2 Diabetes

Objectives: To estimate the optimal statin therapy including statin intensity, low-density lipoprotein cholesterol (LDL-C) level and duration of statin therapy among patients with type 2 diabetes (T2D) in a real-world setting. Research Design and Methods: From the Korean National Health Insurance Service Cohort (2007-2015), 8,937 patients with T2D (≥40 years) who had received statin therapy for at least 90 days were included. Risk of major adverse cardiovascular events (MACE) including coronary heart disease (CHD), ischemic stroke (IS) and cardiovascular death was estimated according to statin intensity, on-treatment serum concentration of LDL-C and duration of statin therapy, respectively. The relative contribution of these three factors for the risk of MACE was quantified by calculating the proportion of log-likelihood explained by each factor. Results: The hazard ratio (HR) of MACE was higher in patients receiving low intensity statins compared with those receiving moderate-to-high intensity statins (HR 1.38, p=0.027). As a reference to LDL-C of 100 mg/dl, below 80 mg/dl was associated with lower risk of MACE. Among patients who received moderate-to-high intensity statins, there was a trend that the longer the duration of statin therapy, the lower the risk of MACE; and HRs of MACE reduced significantly after at least 18 months of statin therapy (adjusted HR 0.71, p=0.011) as a reference to 3 months of statin therapy. The proportion of explainable log-likelihood for MACE was biggest for duration of statin (0.047), followed by statin intensity (0.013) and on-treatment LDL-C level (0.001). Conclusion: Longevity of statin therapy is as important as, or more important than, statin intensity or achieved LDL-C for the reduction of cardiovascular risk in T2D patients. Disclosure J. Kim: None. J. Choi: None. S. Kim: None. N. Kim: None.