Age-related patterns of medical therapy in diabetic patients with cardiovascular disease

Background

Guideline-based medical therapy (GBMT), including sodium–glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), statins, and aspirin, has been associated with improved clinical outcomes in high-risk patients with diabetes.

The present study aimed to assess the association between age and the use of GBMT in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD).

Methods

The CARdiovascular and DIABetes (CARDIAB) cohort was derived from the Health Services database. Patients with T2D and concomitant ASCVD were included. Patients were stratified into three age groups: ≤60, 61–74, and ≥75 years. Prescription rates of SGLT2i, GLP-1RA, statins, and aspirin were compared across the three age groups.

Results

A total of 138,397 patients were included, with a median age of 72.8 ± 10 years, of whom 40% were women. The use of SGLT2i and GLP-1RA declined markedly with increasing age. SGLT2i treatment rates were 54.8%, 37.6%, and 20.1% among patients aged ≤60, 61–74, and ≥75 years, respectively (p < 0.001). Corresponding GLP-1RA treatment rates were 42.8%, 20.9%, and 9.2%, respectively (p < 0.001). In contrast, treatment rates with statins and aspirin did not differ significantly across age groups. Follow-up in cardiology and diabetes clinics was significantly more frequent among younger patients.

Conclusions

In this large real-world cohort of patients with concomitant T2D and ASCVD, the use of SGLT2i and GLP-1RA was substantially lower among older patients, despite guideline recommendations that are not age-dependent. These findings highlight a significant age-related treatment gap and underscore the need for targeted strategies to improve the implementation of evidence-based therapies in elderly patients.