Treatment Patterns of Lipid-Lowering Therapy in Patients with Coronary Artery Disease Aged Above and Below 75 Years: A Retrospective Cross-Sectional Study of 1500 Patients in a Tertiary Care Referral Center in Germany.

INTRODUCTION: Lipid-lowering therapy of elderly patients with coronary artery disease (CAD) inherits a medical challenge, as these patients experience a higher absolute risk reduction but may be more prone to side effects. We aimed to evaluate the treatment patterns in lipid-lowering therapy, comparing CAD patients above versus below 75 years of age. METHODS: We retrospectively included patients with known CAD admitted to the West German Heart and Vascular Center. Low-density lipoprotein cholesterol (LDL-C) levels and intensity of statin therapy (based on dosage and type of statin) were assessed from all available hospital records. RESULTS: We included 1500 patients (mean age 68.4 ± 11.2 years, 75.7% male) from 813 referring treating primary care physicians in 98 cities of Germany in our analysis. A total of 982 patients were < 75 years of age, whereas 518 were ≥ 75 years of age. LDL-C levels did not differ between age groups (≥ 75: 96.0 ± 35.1 mg/dl; < 75: 98.9 ± 35.8 mg/dl, p = 0.13). Simvastatin was most frequently prescribed in both age groups (54.9% vs. 50.7% for age ≥ 75 vs. < 75 years, p = 0.16), followed by atorvastatin (31.6% vs. 33.3%, p = 0.53). Elderly patients received slightly lower statin doses as compared to patients < 75 years of age (28.8 ± 12.8 mg vs. 31.4 ± 13.7 mg, p = 0.0007). Interestingly, patients ≥ 75 years of age achieved LDL-C < 70 mg/dl slightly more frequently than younger patients (24.0% vs. 20.1%, p = 0.09), while only a minority had LDL-C < 55 mg/dl in both age groups. Excluding patients with myocardial infarction at presentation, creatine kinase levels were not relevantly different between age groups (131.9 ± 450.0 U/l vs. 127.5 ± 111.4 U/l, p = 0.78). CONCLUSION: Patients ≥ 75 years of age receive lower doses of statin therapy and reach slightly lower LDL-C levels. However, the majority of elderly patients miss current recommendations regarding LDL-C thresholds.

Disconcordance between ESC prevention guidelines and observed lipid profiles in patients with known coronary artery disease.

BACKGROUND: We aimed to describe whether updated low-density lipoprotein (LDL)-targets in patients with manifest coronary artery disease (CAD) led to a change in lipid profile over time. METHODS: We retrospectively included patients with manifest CAD from 2009-2010, 2012-2013, and 2015-2016 (n = 500 each). Lipid levels and medication at the different time-points as well as rate of accordance to guidelines (<100 for 2009-2010, <70 mg/dl for 2012-2013 and 2015-2016) were evaluated. RESULTS: Overall, 1500 subjects (mean age: 68.4 ±â€¯11.2 years, 75.8% male) from 813 attending primary care physicians were included. Mean LDL-level was 98.0 ±â€¯35.7 mg/dl, whereas 34.1% reached LDL-targets according to guidelines as applied at each time-point. Reduction of LDL-goals in 2011 lead to an initial decrease in LDL from 98.3 ±â€¯33.4 mg/dl in 2009-2010 to 93.9 ±â€¯36.3 mg/dl in 2012-2013 (p = 0.045). This effect was no longer present in 2015-2016 (101.6 ±â€¯36.6 mg/dl, p = 0.17). The rate of patients meeting recommended LDL-targets decreased over time (2009-2010: 56.6%, 2012-2013: 25.4%, 2015-2016: 20.2%, p < 0.0001 for trend). Likewise, the frequency of statin-intake decreased over time (93.6% in 2009-2010 to 83.7% in 2015-2016, p < 0.0001). While use of medium intensity statins was most frequent (69.4%), only 20.9% of patients with medium intensity statins reached LDL-targets according to guidelines. CONCLUSION: In a large clinical cohort of patients with known coronary artery disease, reduction of LDL-targets in ESC-guidelines in 2011 led to an initial decline in LDL-levels, while this effect was attenuated over time with the majority of patients missing treatment goals. Higher acceptance and compliance of statin therapy is warranted to utilize its effect in secondary prevention in CAD-patients.