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Multicenter Study
. 2023 Apr;71(4):1243-1249.
doi: 10.1111/jgs.18172. Epub 2022 Dec 20.

Lipid-lowering treatment among older patients with atherosclerotic cardiovascular disease

Michael G Nanna  1 , Adam J Nelson  2 , Kevin Haynes  3 , Sonali Shambhu  3 , Zubin Eapen  4 , Mark J Cziraky  3 , Sara B Calvert  2   5 , Neha J Pagidipati  2 , Christopher B Granger  2
Affiliations
Multicenter Study

Lipid-lowering treatment among older patients with atherosclerotic cardiovascular disease

Michael G Nanna et al. J Am Geriatr Soc. 2023 Apr.

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.

Keywords: PCSK9i; atherosclerosis; ezetimibe; older adults; predictors; prevention; secondary prevention; statins.

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Conflict of interest statement

Nanna MG: Dr. Nanna reports current research support from the American College of Cardiology Foundation supported by the George F. and Ann Harris Bellows Foundation and salary support from the National Institute on Aging/National Institutes of Health from R03AG074067 (GEMSSTAR award).

Nelson, AJ: Grants from Diabetes Australia and the Royal Australasian College of Physicians.

Haynes K: Employee of HealthCore, subsidiary of Anthem

Shambhu S: Employee of HealthCore, subsidiary of Anthem

Eapen Z: Previous employee of HealthCore

Cziraky MJ: Employee of HealthCore, subsidiary of Anthem

Calvert SB: Supported by US FDA grant U18FD005292 and CTTI membership fees https://www.ctticlinicaltrials.org/membership/annual-membership-fees.

Pagidipati N: Grants from Amgen, AstraZeneca, Boehringer Ingelheim, Cleerly, Eggland’s Best, Eli Lilly, Novartis, Novo Nordisk, Regeneron, Sanofi, Verily Life Sciences. Consulting fees from Boehringer Ingelheim, CrisprTx, Eli Lilly, AstraZeneca/Novartis, and Novo Nordisk.

Granger CB: Research grants and consulting/speaker fees from Boehringer Ingelheim, Bristol-Myers Squibb, Janssen Pharmaceutica Products, L.P., and Pfizer, research grants from AKROS, Apple, AstraZeneca, Daichii-Sankyo, US Food & Drug Administration, GlaxoSmithKline, Medtronic Foundation, and Novartis Pharmaceutical Company, consulting/speaker fees from Abbvie, Bayer Corp US, Boston Scientific Corp, CeleCor Therapeutics, Correvio, Espero BioPharma, Medscape, Medtronic Inc., Merck, National Institutes of Health, NovoNordisk, Rhoshan Pharmaceuticals, and Roche Diagnostics.

Figures

Figure 1.
Figure 1.. Lipid-lowering treatment among older patients with ASCVD.
Figure 1 demonstrates lipid-lowering treatment rates in older adults including statin, high-intensity statin, and non-statin lipid-lowering therapy utilization. Also demonstrated are poorly controlled LDL-C levels in this population despite high persistence and adherence to treatment among treated with high-intensity statins.
See this image and copyright information in PMC

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