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Impact of Age on Lipid-Lowering Therapy Prescriptions and LDL-Cholesterol Control: Insights from the PORTRAIT-DYS
Cristina Gavina1,2,3, Daniel Seabra1, Sílvia Oliveira1,4
1Cardiology Department, ULS Matosinhos, 4464-513 Senhora da Hora, Matosinhos, Portugal.
Insights
Lipid-lowering therapy (LLT) for atherosclerotic cardiovascular disease (ASCVD) risk patients shows low low-density lipoprotein cholesterol (LDL-C) control. Older patients achieve LDL-C goals more often than middle-aged patients, despite less intensive LLT.
Area of Science:
- Cardiovascular Medicine
- Pharmacotherapy
- Public Health
Background:
- Guidelines for lipid-lowering therapies (LLT) for high and very-high atherosclerotic cardiovascular disease (ASCVD) risk patients exist, yet a gap remains between recommended low-density lipoprotein cholesterol (LDL-C) management and clinical practice.
- Patient age is a potential factor influencing this treatment gap.
Purpose of the Study:
- To characterize LLT prescription patterns in middle-aged and older adults with high and very-high ASCVD risk.
- To estimate the impact of age on achieving LDL-C control.
Main Methods:
- A cohort study analyzed electronic health records from a Portuguese healthcare institution (2012-2022).
- Middle-aged (40-69 years) and older (70-85 years) patients with high/very-high ASCVD risk were included.
- LLT prescriptions were categorized into six patterns based on statin intensity and ezetimibe use.
- Multivariate Cox regressions compared LDL-C control rates at 150 and 360 days between age cohorts.
Main Results:
- 36,866 patients and 407,500 LLT prescriptions were analyzed.
- High-intensity statins were more common in middle-aged patients (12.0% vs. 8.6%), while older patients more frequently received low-intensity statins (8.6% vs. 5.9%).
- Older patients showed a higher likelihood of achieving LDL-C goals at 150 days (HR=1.32) and 360 days (HR=1.27).
Conclusions:
- LDL-C control remains suboptimal in high/very-high ASCVD risk patients in this Portuguese cohort.
- Middle-aged adults exhibited particularly low achievement rates despite higher use of intensive LLT.
- Optimized, age-specific treatment strategies are needed to improve LDL-C control.
Background:
Despite clear guidelines for lipid-lowering therapies (LLT) for patients with high and very-high atherosclerotic cardiovascular disease (ASCVD) risk, a significant gap persists between recommended low-density lipoprotein cholesterol (LDL-C) management and actual clinical practice, leaving a large proportion of patients without adequate treatment. Patient age is one of several factors that may play a role in this gap.
Objectives:
We characterized LLT prescription patterns among middle-aged and older adults with high and very-high ASCVD risk and estimated the effect of age in achieving LDL-C control.
Methods:
This cohort study used electronic health records of a Portuguese healthcare institution from January 2012 to December 2022. Middle-aged (40-69 years) and older (70-85 years) patients with high and very-high ASCVD risk were analysed. Exposure consisted of LLT prescriptions. LLT prescriptions were characterized in six dynamic patterns based on statin intensity (high, moderate, low) and the addition of ezetimibe. Risk for LDL-C control at 150 and 360 days was compared between the two age cohorts using multivariate Cox regressions.
Results:
A total of 36,866 patients were identified, accounting for 407,500 LLT prescriptions. High-intensity statins were more frequently prescribed to middle-aged patients (12.0% vs. 8.6% older), whereas older patients more often received low-intensity statins (8.6% vs. 5.9% middle-aged). The use of statin-ezetimibe combinations was low across all age groups (0.1-1.4%). At 150 and 360 days of follow-up, LDL-C targets were achieved in 2,661 (0.7%) and 14,047 (3.8%) prescriptions, respectively. Older patients had a 32% higher rate of reaching LDL-C goals at 150 days (HR = 1.32, 95% CI = 1.19-1.45) and 27% at 360 days (HR = 1.27, 95% CI = 1.19-1.35).
Conclusion:
LDL-C control remains low in high- and very-high-risk patients from a Portuguese integrated health care unit, with particularly low achievement rates among middle-aged adults, despite their higher use of high-intensity LLT. These findings highlight the need for optimized treatment strategies, including age-specific approaches.
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