Statin therapy in elderly high cardiovascular risk populations: a comprehensive analysis of the AGING HEART Zurich Cohort

Abstract Introduction/Background Cardiovascular disease remains the leading cause of morbidity and mortality globally, particularly affecting the elderly. Statin therapy has been widely established as an effective means of lowering LDL cholesterol levels and reducing cardiovascular events in high-risk populations. Purpose This study aimed to evaluate adherence to LDL-C targets for elderly patients at very high cardiovascular risk and assess guideline adherence at the first point of contact within our institution. Method We conducted a retrospective analysis of patient data from the AGING HEART Zurich Cohort. Adult patients hospitalized between 2015 and 2024 were categorized based on their ASCVD risk using the ESC SCORE2 criteria. Additionally, patients were divided into two age groups: those aged ≥80 years (very elderly) and those aged 65-79 years (elderly). The primary outcome was the degree of guideline-directed medical treatment, measured by LDL concentration. Results Our analysis included 3,237 patient datasets from the AGING HEART Zurich cohort, collected during each patient's first contact with the hospital. The cohort comprised 67.2% men and 32.8% women, with average ages of 76.7 ±7.3 years for men and 78.5 ±7.3 years for women. A total of 82.7% of patients were classified as "very high risk" according to SCORE2 or SCORE-OP. Statin therapy was administered to 66.7% of these patients. There was no significant difference in statin treatment rates between the two age groups (65-79 years: 67.9%; over 80 years: 65.1%; Chi-square=0.09). Additionally, there was no significant difference in achieving LDL targets between very high-risk and non-very high-risk patients (very high risk: 2.2 ±1 mmol/L vs. non-very high risk: 2.2 ±0.9 mmol/L). However, a significant difference was observed in the achievement of an LDL target of 1.4 mmol/L between the two age groups of very high-risk patients (very elderly: 44.9%; elderly: 59.3%; p=0.0001). Conclusion Overall, the achievement of LDL-C goals in patients at very high ASCVD risk was better than reported in previous studies, however still suboptimal. Both patients over and under 80 years were similarly likely to receive statin treatment. Notably, a significant disparity existed in the ability of very high-risk patients aged above and below 80 to reach LDL targets.