{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:15:42Z","timestamp":1785424542074,"version":"3.56.0"},"posted":{"date-parts":[[2026,5,26]]},"group-title":"Endocrinology (including Diabetes Mellitus and Metabolic Disease)","reference-count":43,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"award":["IK2CX001907"],"award-info":[{"award-number":["IK2CX001907"]}],"id":[{"id":"https:\/\/ror.org\/05rsv9s98","id-type":"ROR","asserted-by":"publisher"}]},{"award":["I01CX001532"],"award-info":[{"award-number":["I01CX001532"]}],"id":[{"id":"https:\/\/ror.org\/05rsv9s98","id-type":"ROR","asserted-by":"publisher"}]},{"award":["P30DK116073"],"award-info":[{"award-number":["P30DK116073"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]},{"award":["R38HL143511"],"award-info":[{"award-number":["R38HL143511"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]},{"award":["Webb-Waring Biomedical Research Award"],"award-info":[{"award-number":["Webb-Waring Biomedical Research Award"]}],"id":[{"id":"https:\/\/ror.org\/0277pn602","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Despite the benefits of statin therapy in individuals with diabetes, fewer than 70% of adults with diabetes meet contemporary guidelines for statin therapy and reducing low-density lipoprotein cholesterol (LDL) to &lt;100 mg\/dL. Evidence describing delays in statin initiation after diabetes diagnosis and associated clinical outcomes may motivate process of care interventions to improve guideline recommended care in individuals newly diagnosed with type 2 diabetes mellitus (T2D).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To examine the timing of statin initiation and achievement of LDL &lt;100 mg\/dL after diabetes diagnosis, and to determine the association of early LDL reduction among statin initiators with incident atherosclerotic cardiovascular disease (ASCVD).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective observational cohort study using data from 2005-2021<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Veterans Affairs Health Care System (VA)<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Individuals with newly diagnosed T2D<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Exposure<\/jats:title>\n                  <jats:p>Primary exposure was ASCVD risk based on ACC\/AHA Pooled Cohort Equations; secondary exposure was LDL &lt;100 mg\/dL in the first year after T2D diagnosis among statin initiators<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures<\/jats:title>\n                  <jats:p>Co-primary outcomes were initiation of statin therapy and achievement of LDL &lt;100 mg\/dL within 5 years of diabetes diagnosis; incident 5-year ASCVD was a secondary outcome.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 100,406 individuals with newly diagnosed T2D, 59,615 were prescribed statin therapy within five years (59.4%), and 44,783 (57.5%) of those with LDL above goal achieved LDL &lt;100 mg\/dL within 5 years. Relative to those at low (&lt;7.5%) 10-year ASCVD risk, individuals at intermediate (7.5-20%) and high (&gt;20%) risk were more likely to be initiated on a statin (intermediate: Hazard Ratio [HR] 1.14 [95% CI 1.11, 1.17]; high: HR 1.16 [95% CI 1.13, 1.19]) and to achieve LDL &lt;100 mg\/dL (intermediate: HR 1.23 [95% CI 1.19, 1.26]; high: HR 1.34 [95% CI 1.30, 1.38]). Among those prescribed a statin within one year of diabetes diagnosis, achieving LDL &lt;100 mg\/dL in the first year after diabetes diagnosis was associated with lower risk of 5-year incident ASCVD (HR 0.84 [95% CI 0.77, 0.92]).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions and Relevance<\/jats:title>\n                  <jats:p>Gaps in guideline-directed primary prevention of ASCVD arise early following initial diabetes diagnosis. Guideline recommended early LDL lowering among statin initiators was associated with improved clinical outcomes.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.24.26354000","type":"posted-content","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T02:10:16Z","timestamp":1779847816000},"source":"Crossref","is-referenced-by-count":0,"title":["Gaps in lipid management after diabetes diagnosis and associated cardiovascular outcomes in a cohort of US adults"],"prefix":"10.64898","author":[{"given":"Alexander M.","family":"Heilman","sequence":"first","affiliation":[{"name":"Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO"},{"name":"Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Warsavage","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO"},{"name":"Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter W.F.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Atlanta VA Medical Center, Decatur, GA"},{"name":"Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence S.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Atlanta VA Medical Center, Decatur, GA"},{"name":"Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E.B.","family":"Reusch","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO"},{"name":"Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0643-4873","authenticated-orcid":false,"given":"Sridharan","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO"},{"name":"Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026052804450844000_2026.05.24.26354000v1.1","doi-asserted-by":"crossref","unstructured":"Raghavan S , Vassy JL , Ho Y-L , et al. 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