Lipid‐lowering treatment among older patients with atherosclerotic cardiovascular disease. Issue 4 (20th December 2022)

• Record Type: Journal Article
• Authors: Nanna, Michael G.; Nelson, Adam J.; Haynes, Kevin; Shambhu, Sonali; Eapen, Zubin; Cziraky, Mark J.; Calvert, Sara B.; Pagidipati, Neha J.; Granger, Christopher B.
• Is Part Of: Journal of the American Geriatrics Society. Volume 71:Issue 4(2023)
• Page Start: 1243
• Page End: 1249
• Publication Date: 2022-12-20
• Subjects: atherosclerosis -- ezetimibe -- older adults -- PCSK9i -- predictors -- prevention -- secondary prevention -- statins; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.18172
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract: Background: The contemporary uptake of lipid‐lowering therapies (LLT), including more intensive treatment with high‐intensity statins and non‐statin LLT, among U.S. older adults (≥75 years old) with ASCVD is unknown. Methods: In this multicenter retrospective cohort study of a large geographically diverse sample of commercially insured U.S. older adults with ASCVD, we assessed treatment with LLT. Secondary measures included LDL‐C above target ≥70 mg/dl, persistence and adherence to therapy. Results: Treatment with statins, high‐intensity statins, ezetimibe, and PCSK9 inhibitors was assessed in 194, 503 older adults (49.9% female) with known ASCVD on January 31st, 2019. 49.3% of older adults with ASCVD were on any statin, with 16.6% receiving a high‐intensity statin and 32.7% on low‐or moderate‐intensity statins. Treatment with ezetimibe (2.4%) or PCSK9 inhibitors (0.24%) was rare and 62.6% of the overall cohort had an LDL‐C above target at ≥70 mg/dl. Patients on high‐intensity statins were more frequently male, had a diagnosis of coronary artery disease, and were more frequently seen by a cardiologist compared with those on low‐or moderate‐intensity statins and untreated individuals ( p < 0.0001). The majority of older adults on high‐intensity statins remained on therapy at 12 months (91.9%) and 85.7% had ≥75% adherence to treatment. Conclusions: Less than half of eligible older adults with ASCVD are on statins and only a minority of patients are receiving more intensive lipid‐lowering to improve outcomes.