Your new experience awaits. Try the new design now and help us make it even better

ORIGINAL RESEARCH article

Front. Pharmacol.

Sec. Drugs Outcomes Research and Policies

Volume 16 - 2025 | doi: 10.3389/fphar.2025.1588376

This article is part of the Research TopicPharmacoepidemiology in Chronic DiseasesView all 16 articles

Predictors and benefits of lipid-lowering therapy initiation after an atherosclerotic cardiovascular event: a retrospective cohort study

Provisionally accepted
  • 1Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Lombardy, Italy
  • 2IRCCS MultiMedica, Sesto S. Giovanni (MI), Italy, Sesto San Giovanni (MI), Italy
  • 3Center of Research, S.A.V.E. Studi - Health Economics and Outcomes Research, Milan, Italy, Pavia, Italy
  • 4Department of Drug Sciences, University of Pavia, Italy, Pavia, Italy
  • 5Research laboratory of lipid disorders and atherosclerosis, Almazov National Medical Research Centre, Saint Petersburg, Russia, Saint Petersburg, Russia

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

Background Guidelines recommend lipid-lowering therapy (LLT) after an atherosclerotic cardiovascular disease (ASCVD) event. This study investigated real-world LLT initiation rate and its effect on total mortality in the Lombardy region.Methods Individuals aged ≥40 with an ASCVD event between January and September 2022 were identified from Lombardy's administrative data. The prevalence of LLT initiation within 3 months was estimated, and factors influencing treatment initiation were evaluated using multivariate logistic regression (odds ratios [OR] and 95% confidence intervals [95% CI]). One-year post-event mortality was analyzed. Results Among 16,025 patients 41.14% did not receive a LLT after an ASCVD event. Treatment initiation was more likely in subjects hospitalized for a cardiovascular event (OR 2.22, 95%CI 2.07-2.38, vs cerebrovascular event), in patients aged 51-60 years (OR 1.30, 95%CI 1.16-1.46), and in patients previously treated with antidiabetic (OR 1.42, 95%CI 1.25-1.62), antihypertensive (OR 1.96, 95%CI 1.80-2.13), and thyroid hormone replacement medications (OR 1.34,. Conversely, older age (71-80 years: OR 0.79, 95%CI 0.71-0.87; >80 years: OR 0.47, 95%CI 0.42-0.52), female sex (OR 0.73, 95%CI 0.68-0.79), previous exposure to antithrombotic medications (OR 0.65, 95%CI 0.59-0.72), and polypharmacy (OR 0.90, 95%CI 0.81-0.99 for 5-9 medications, OR 0.61, 95%CI 0.52-0.72 for ≥10 medications) reduced the likelihood of treatment. Mortality at 1 year was 3.07% in treated versus 11.66% in untreated patients (p-value <0.001).This study underscores a suboptimal LLT initiation rate in post-ASCVD patients. Initiating LLT is associated with significantly reduced 1-year total mortality, highlighting the need to optimize secondary prevention strategies.

Keywords: Lipid-lowering therapies, atherosclerotic cardiovascular event, Secondary Prevention, guidelines compliance, Treatment outcomes

Received: 05 Mar 2025; Accepted: 04 Sep 2025.

Copyright: © 2025 Casula, Scotti, Galimberti, Bruno, Colombo, Alieva, Xie, Catapano and Olmastroni. 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: Manuela Casula, Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Lombardy, Italy

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.