Statin therapy optimization in older adults: interim results of a randomized controlled trial of pharmacist-led pharmaceutical care

Statin optimization in older adults is increasingly relevant within the geroscience framework of cardiovascular ageing. This randomized controlled trial evaluated whether pharmacist-led pharmaceutical care improves lipid outcomes and statin adherence in community-dwelling older adults receiving primary care. A total of 99 patients aged 65 years or older on long-term statin therapy were randomized to usual care or structured pharmacist-led care delivered every 3 months. The primary outcome was change in low-density lipoprotein cholesterol at 6 months. Secondary outcomes included changes in other lipid parameters and dispensing-based adherence assessed by the proportion of days covered. The present analysis represents a pre-specified interim evaluation and was conducted on a per-protocol population with complete 6-month laboratory data. No statistically significant between-group difference in low-density lipoprotein cholesterol reduction was observed (adjusted difference -0.129 mmol/L, p = 0.385). Statin adherence was high and stable in both groups throughout follow-up, with 84-87% of patients meeting adherence thresholds and approximately 75-77% achieving perfect dispensing, consistent with an apparent ceiling effect. Exploratory sex-stratified analyses identified potential differences in lipid responses, but these were not statistically robust. In these highly adherent elderly populations, pharmacist-led pharmaceutical care was not associated with additional short-term improvement in LDL-C or dispensing-based adherence. The findings highlight the importance of baseline adherence when evaluating adherence-focused interventions in older adults.