Abstract
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.