Skip to main content


Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1357334
This article is part of the Research Topic Women in Drugs Outcomes Research and Policies: 2023 View all 9 articles

Implementation of Risk-based Lipid-lowering Therapies in Older (age ≥ 65 years) and Very-old Adults (age ≥ 75 years) with Ischemic Heart Disease in the Greater Salzburg Region

Provisionally accepted
  • 1 Salzburg State Clinics, Paracelsus Medical University, Salzburg, Austria
  • 2 Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria
  • 3 Medical school, Johannes Kepler University of Linz, Linz, Upper Austria, Austria

The final, formatted version of the article will be published soon.

    European guidelines recommend implementation of lipid-lowering therapies (LLTs) in adults (> 65 years) with established atherosclerotic cardiovascular disease (ASCVD) and for risk-based primary prevention in older adults (< 75 years) yet their use in very-old adults (> 75 years) is controversial, discretionary, and oriented on the presence of risk factors. Aim of this retrospective study is to assess guideline-directed LLT implementation and LDL-C target achievement in high-/very-high-risk older/very-old adults (65-74, >75years) at presentation for ST-segment elevation myocardial infarction (STEMI), also to assess evidence-based care delivery to older adults in our region. Methods: All STEMI patients with available LDL-C and total cholesterol presenting for treatment at a large tertiary center in Salzburg, Austria 2018-2020 were screened (n=910). High-risk/very-highrisk patients (n=369) were classified according to European guidelines criteria and divided into cohorts by age: <65 years (n=152), 65-74 years (n=104), >75 years (n=113). Results: Despite high-/very-high-risk, prior LLT use was < 40% in the total cohort with no significant difference by age.Statin monotherapy predominated, 20-23% of older/ very-old adults in the entire cohort were using low-/moderate-intensity stains, 11-13% high-intensity statins, 4% ezetimibe therapy, none taking PCSK9 inhibitors. In the secondary prevention cohort, 53% of older/ very-old patients used prior LLTs. Significantly higher percentages of older/oldest ASCVD patients (43%, 49%) met LDL-C targets < 70 mg/dL compared to patients <65 years (29% p= 0.033), and just 22% and 30% attained stricter < 55 mg/dL LDL-C targets. Low LLT uptake (16%) among older adults 64-74 years for primary prevention resulted in 17% and 10% attainment of risk-based LDL-C targets < 70 mg/dL and < 55 mg/dL respectively. Oldest adults >75 years in both primary and secondary prevention groups more often met risk-based targets than older and younger adults, despite predominant low-/moderateintensity statin monotherapy. Conclusion: Secondary prevention was sub-optimal in our region. Less than half of older/ very-old adults with established ASCVD met LDL-C targets at time of STEMI, suggesting severe care-delivery deficits in LLT implementation. Shortcomings in initiation of riskbased LLTs were also observed among high-/very-high-risk primary prevention patients <75 years with achievement of risk-based LDL-C targets in 10-48% of these patients.

    Keywords: older adults, LDL-C, Lipid-lowering Therapy LLT, guidelines, STEMI, Very-high risk

    Received: 28 Dec 2023; Accepted: 17 May 2024.

    Copyright: © 2024 Kopp, Motloch, Wernly, Berezin, Maringgele, Dieplinger, Hoppe and Lichtenauer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Kristen L. Kopp, Salzburg State Clinics, Paracelsus Medical University, Salzburg, Austria

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.