Does guideline directed statin intensity (high-intensity statins) reduce recurrent ASCVD events and mortality in older adults (>75 years) with established ASCVD compared to lower intensity or no statin?
High-intensity statin therapy is significantly underutilized in older adults (>75 years) with ASCVD, despite being associated with substantial reductions in recurrent MI, stroke, and mortality compared to lower-intensity therapy.
Introduction: The ACC/AHA guidelines recommend that patients with established ASCVD should be on high intensity statins for secondary prevention. Prior data suggests that older adults (>75 years) are sub-optimally treated for both primary and secondary prevention of ASCVD events. We investigated guideline directed statin intensity (GDSI) use, associated LDL cholesterol levels and ASCVD outcomes in a cohort of older adults in a large healthcare network. Methods: EMR data was abstracted to assess statin prescriptions between 2010-2020 amongst adults with known ASCVD (CAD, ischemic stroke/TIA or PAD). Prescriptions of statins as GDSI (high intensity), 75 years (n=11,596), less than half (49.6%) were on GDSI and only ~54% older adults achieved LDL-c75y 1.59; 95% CI (1.30-1.95)], stroke HR>75 1.659; 95% CI (1.21-2.24) and mortality HR>75 1.88; 95% CI (1.57-2.25); all p75y. Systemic interventions for guideline implementation and optimal statin use in older adults with ASCVD should be explored further.
Acharya et al. (Tue,) studied this question.