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The role of age on lipid-lowering therapy prescriptions and on low-density lipoprotein cholesterol (LDL-C) control: a subanalysis of the PORTRAIT-DYS study
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 01– DOS LÍPIDOS AOS GENES - FATORES DE RISCO E BIOLOGIA MOLECULAR NA ATEROSCLEROSE E SAÚDE CARDIOVASCULAR
Speaker:
Cristina Gavina
Congress:
CPC 2025
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.4 Lipids
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Cristina Gavina; Daniel Seabra; Sílvia Oliveira; Carla Teixeira; Jorge A. Ruivo; Nuno Lourenço-Silva; Rita Luz; Cristina Jácome; Francisco Araújo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Lato,sans-serif">Lifelong exposure to high cholesterol levels represents a risk factor for atherosclerotic cardiovascular disease (ASCVD). We characterized lipid-lowering therapies (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.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Lato,sans-serif">This retros<span style="background-color:white">pective cohort study used electronic health records of a Portuguese healthcare institution from Jan 1, 2012 to Dec 31, 2022. Patients aged 40-85 yrs and with high and very-high ASCVD risk were analysed. Exposure consisted of any time a LLT was prescribed (regardless of duration). Two age cohorts were defined (middle-aged 40–69 yrs; older 70–85 yrs), along with six LLT prescription patterns based on statin intensity (high, moderate, low) and the addition of ezetimibe to each intensity group. A patient could be eligible for multiple cohorts as they could have multiple LLT prescription episodes. The likelihood of reaching the LDL-C goal between 150-360 days of follow-up according to ESC/EAS guidelines was modelled using multivariate </span><span style="background-color:white">Cox regression</span><span style="background-color:white"> adjusted at baseline for age group, sex, comorbidities and LLT intensity.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Lato,sans-serif">A total of<span style="background-color:white"> 31 755 patients with 408 219 episodes of LLT prescription were identified (Table 1). Most LLT prescriptions were from the middle-aged cohort (229 602, 56.2%). In both cohorts, statins in monotherapy (moderate 78.4%, high 10.3%, low 6.9% intensity) were more commonly prescribed than statin-ezetimibe combinations (moderate 2.6%, high 1.6%, low 0.2% intensity). The use of moderate intensity statin in monotherapy was similar across cohorts (middle-aged 77.7%, older 79.3%), but patients in the middle-aged cohort were more frequently prescribed high intensity (11.8% vs older 8.5%), while older were more frequently prescribed low intensity (8.4% vs middle-aged 5.7%). The prescription of statin-ezetimibe combinations was similar across cohorts</span>. At 150 days of follow up, only 4 301 (1.2%) episodes reached LDL-C goal, which increased to 20 909 (5.9%) episodes at 360 days. The older cohort had 18% higher likelihood of reaching the LDL-C goal at 150 days (HR=1.18, 95%CI 1.09-1.28) and 14% higher likelihood at 360 days (HR=1.14, 95%CI 1.08-1.20) compared to the middle-aged cohort.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Lato,sans-serif"><span style="background-color:white">LDL-C control in high and very-high risk patients remains suboptimal, with particularly low rates in middle-aged adults, </span><span style="background-color:white">despite receiving more frequent high-intensity LLT</span><span style="background-color:white">. This underscores the importance of combined therapies and age-specific strategies </span>in managing dyslipidaemia to decrease lifelong high LDL-C exposure.</span></span></p>
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