{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:15:01Z","timestamp":1780445701071,"version":"3.54.1"},"reference-count":43,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,4]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Adults with type 1 diabetes (T1D) are at markedly elevated risk of atherosclerotic cardiovascular disease (ASCVD). Guidelines recommend statin use for ASCVD prevention in diabetes between the ages of 40 and 75 years. This study aimed to evaluate statin prescribing rates for primary and secondary prevention of ASCVD in this age range with T1D and to identify disparities and barriers to optimal statin use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design, setting, and participants<\/jats:title>\n                    <jats:p>A retrospective cross-sectional study of 266 adults with T1D aged 40\u201375 years was conducted at an integrated health system between 2020 and 2024. Demographic features, statin prescribing patterns, low-density lipoprotein (LDL) cholesterol levels and use of additional lipid-lowering agents were extracted from medical records. Barriers to prescribing were identified via endocrine physician documentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 266 adults with T1D aged 40\u201375 years, only 43.2% (95% CI 0.37 to 0.49) were prescribed guideline-recommended statin and 39.3% of those with a history of ASCVD received a high-intensity statin. Overall, 47.7% (95% CI 0.42 to 0.54) of patients achieved the latest LDL cholesterol targets, and 53.0% (95% CI 0.47 to 0.59) if using pre-2023 targets. Deferral to another healthcare professional (23.3%), statin intolerance (15.8%), and clinical inertia (9.0%) were the most common barriers to therapy. In multivariable analyses, female sex was independently associated with lower odds of receiving guideline-recommended statin therapy (aOR 0.45, 95%\u2009CI 0.24 to 0.85, p=0.015) and lower odds of achieving LDL targets (OR 0.43, 95%\u2009CI 0.28 to 0.64, p=0.046), while ASCVD history was associated with higher odds of statin use (aOR 2.75, 95%\u2009CI 1.34 to 5.57, p=0.005). Very few patients received adjunctive lipid-lowering agents (ezetimibe 4.1%, PCSK9 inhibitor 0.4%, none on bempedoic acid).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Notable gaps exist in statin prescribing and LDL goal attainment among adults with T1D, particularly women. Efforts to enhance care coordination, promote healthcare professional education and expand the use of adjunctive lipid-lowering therapies may help improve cardiovascular prevention in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112682","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T21:56:00Z","timestamp":1773870960000},"page":"e112682","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Statin prescription rates for prevention of atherosclerotic cardiovascular disease in adults 40\u201375 years old with type 1 diabetes"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7137-1365","authenticated-orcid":false,"given":"Michelle Diane","family":"Lundholm","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Diabetes, and Metabolism, Medical Specialties Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026031814553264000_16.3.e112682.1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10081798","article-title":"Cardiovascular Disease in Type 1 Diabetes Mellitus: Epidemiology and Management of Cardiovascular Risk","volume":"10","author":"Colom","year":"2021","journal-title":"J Clin Med"},{"key":"2026031814553264000_16.3.e112682.2","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-2839"},{"key":"2026031814553264000_16.3.e112682.3","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-019-0806-4"},{"key":"2026031814553264000_16.3.e112682.4","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.294798"},{"key":"2026031814553264000_16.3.e112682.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31506-X"},{"key":"2026031814553264000_16.3.e112682.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.16425"},{"key":"2026031814553264000_16.3.e112682.7","doi-asserted-by":"publisher","DOI":"10.2337\/db10-0862"},{"key":"2026031814553264000_16.3.e112682.8","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S2213-8587(14)70248-7","article-title":"Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis","volume":"3","author":"Huxley","year":"2015","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026031814553264000_16.3.e112682.9","first-page":"2365","article-title":"Primary prevention of major cardiovascular and cerebrovascular events with statins in diabetic patients: a meta-analysis","volume":"72","author":"de Vries","year":"2012","journal-title":"Drugs (Abingdon Engl)"},{"key":"2026031814553264000_16.3.e112682.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2003.02060.x"},{"key":"2026031814553264000_16.3.e112682.11","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1016\/S0140-6736(03)13636-7","article-title":"MRC\/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial","volume":"361","author":"Collins","year":"2003","journal-title":"The Lancet"},{"key":"2026031814553264000_16.3.e112682.12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0140-6736(08)60104-X","article-title":"Efficacy of cholesterol-lowering therapy in 18\u2008686 people with diabetes in 14 randomised trials of statins: a meta-analysis","volume":"371","author":"Kearney","year":"2008","journal-title":"The Lancet"},{"key":"2026031814553264000_16.3.e112682.13","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-2450"},{"key":"2026031814553264000_16.3.e112682.14","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.jacc.2025.07.013","article-title":"Safety and Effectiveness of Statins for Primary Prevention in Adults With Type 1 Diabetes: An Emulation","volume":"86","author":"Blais","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026031814553264000_16.3.e112682.15","doi-asserted-by":"crossref","first-page":"S207","DOI":"10.2337\/dc25-S010","article-title":"10. 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