Age, Gender, and Adherence in Low-density Lipoprotein Cholesterol Reduction with Statin Therapy: A Real-world Cohort Study

Background: Current guidelines recommend achieving ≥50% reduction in low-density lipoprotein cholesterol (LDL-C) in high-risk patients. Real-world data on response patterns, age and gender differences, and determinants of nonresponse remain limited. The aim of the study is to evaluate LDL-C reduction following statin therapy in routine clinical practice and to examine the influence of age, gender, and medication adherence on treatment response and cardiovascular outcomes. Methods: In this observational cohort study, adults initiated on statin therapy with documented baseline and follow-up lipid measurements were included. LDL-C levels were recorded at baseline and follow-up. The primary outcome was achievement of ≥50% LDL-C reduction. Results: In a total study population of 652 patients, statin therapy was associated with substantial early reductions in LDL-C that were largely maintained at 1 year. More than half of the patients achieved a ≥50% reduction, and nearly one-third achieved LDL-C levels <55 mg/dL. Patients >45 years demonstrated greater sustained LDL-C reduction compared with younger individuals. Numerical differences in LDL-C response were observed between men and women, although these were not statistically significant. Failure to achieve ≥50% LDL-C reduction appeared to be more closely associated with lower medication adherence rather than treatment intensity within this uniformly treated cohort. Greater proportional LDL-C reduction was associated with lower cardiovascular event rates during follow-up. Conclusions: In routine practice, approximately half of patients achieved ≥50% LDL-C reduction with high-intensity statin therapy. Adherence emerges as an important determinant of response. Age was associated with sustained response, whereas gender differences were not statistically significant. Nonresponse is primarily associated with modifiable treatment-related factors.