1348-P: Trends and Independent Correlates of Cardioprotective Antihyperglycemic Agent Use in U.S. Adults with Cardiovascular-Kidney-Metabolic Syndrome

Cardiovascular-kidney-metabolic syndrome (CKMS) includes those at risk for and those with CVD. Cardioprotective antihyperglycemic agents (CAA) have beneficial effects on CKMS. The goal of this study is to examine trends and correlates of CAA use among US adults with CKMS. Data from the Medical Expenditure Panel Survey (2008-2021) representing a weighted population of 30,583,033 US adults aged >=18 years with CKMS were used for this analysis. CKMS was defined as individuals diagnosed with type 2 diabetes, CKD, or CHF. The dependent variable was CAA use defined as GLP-1RAs or SGLT2i use (yes/no). Proportion of CAA use over time was examined overall and by demographic characteristics (age, sex, race/ethnicity, poverty, and insurance) controlling for time. Logistic regression models were used to examine the association between CAA use adjusting for relevant covariates. Analyses were conducted using R v 4.3.1 and significance was p-value<0.05. The prevalence of CAA use in 2008 was 6% (n=2,811) in this population. Use of CAA significantly increased overall from 6 to 61% from 2008 to 2021 (p<0.01). After controlling for time, there were significant differences in CAA use by age (p=0.03), sex (p=0.03), race/ethnicity (p=0.01), poverty (p<0.01), and insurance (p=0.04). In fully adjusted model, independent correlates of CAA use were age 45-64years [OR 1.58 (1.24, 2.02)], non-Hispanic Black [OR 0.71 (0.59, 0.89)], college education [OR 1.62 (1.32, 1.99)], unmarried status [OR 0.83 (0.72, 0.96)], unemployment [OR 0.83 (0.72, 0.96)], low poverty [OR 0.76 (0.62, 0.92)], uninsured [OR 0.46 (0.30, 0.69)] or publicly insured [OR 0.79 (0.69, 0.92)], and survey year. CAA use has increased over time however utilization remains suboptimal among US adults with CKMS. Targeted multilevel interventions including policy-level, health system-level, provider-level, and patient-level focusing on individuals most at risk who have CKMS are critical.