Age-stratified analysis of real-world lipid-lowering therapy use and LDL-C goal attainment at 1-year follow-up: insights from the European SANTORINI study

Background Cardiovascular (CV) disease continues to pose a significant global health challenge, particularly among older adults. Evidence from SANTORINI showed that only 30% of patients achieved their low-density lipoprotein cholesterol (LDL-C) goal. However, it remains unclear how this differs across age groups. Purpose To assess age-related differences in lipid-lowering therapy (LLT) use and LDL-C goal attainment in the European SANTORINI cohort of patients at 1-year follow-up (1YFU). Methods SANTORINI was an observational, prospective study that enrolled high- and very high-risk patients from primary and secondary care settings across 14 European countries between March 2020 to February 2021. Patients with non-missing LLT and non-missing LDL-C values at baseline (BL) and 1YFU were included in the full analysis set (FAS) and LDL-C set, respectively. Patients were stratified into three age groups: <60 years, 60–69 years and ≥70 years. LLT use, LDL-C levels and goal attainment (defined as LDL-C <1.8 mmol/L for high-risk patients and <1.4 mmol/L for very high-risk patients, from the 2019 European Society of Cardiology/European Atherosclerosis Society guidelines) were compared at BL vs 1YFU. Results 9136 patients were included in the FAS and 7210 patients were included in the LDL-C set; results are reported at BL vs 1YFU. In patients aged <60 years, 28.5% did not receive LLT at BL, which decreased to 3.6% at 1YFU, monotherapy increased from 40.7% to 48.1% and combination therapy increased from 30.8% to 47.4% (Table). Mean (SD) LDL-C levels decreased from 2.68 (1.42) mmol/L to 2.06 (1.09) mmol/L and goal attainment increased from 20.1% to 31.0% (Figure). In patients aged 60–69 years, the proportion of untreated patients decreased from 20.2% to 3.0%, monotherapy increased from 53.3% to 56.5% and combination therapy increased from 26.5% to 39.4%. Mean (SD) LDL-C levels decreased from 2.42 (1.20) mmol/L to 1.96 (0.90) mmol/L, and goal attainment increased from 21.0% to 31.2%. In patients aged ≥70 years, the proportion of untreated patients decreased from 16.0% to 3.4%, monotherapy increased from 63.1% to 64.1% and combination therapy increased from 21.0% to 29.8%. Mean (SD) LDL-C levels decreased from 2.21 (1.01) mmol/L to 1.94 (0.86) mmol/L, and goal attainment increased from 22.3% to 30.6%. Overall, the proportion of untreated patients decreased from 20.9% to 3.3%, monotherapy increased from 53.6% to 57.1% and combination therapy increased from 25.6% to 37.9%. Mean (SD) LDL-C levels decreased from 2.42 (1.22) mmol/L to 1.98 (0.95) mmol/L, and goal attainment increased from 21.2% to 30.9%. Conclusions This analysis showed that in the real-world older patients are treated less intensively than younger patients. At 1YFU, many older patients were still unable to reach their LDL-C goal, thus highlighting the unmet need for more intensive treatment strategies to improve CV outcomes in the older population.