Abstract 16892: Statin Utilization and Recurrent Cardiovascular Disease Events in a Secondary Prevention Cohort of Older Adults

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), <GDSI (low/moderate intensity), and no statin were assessed and stratified by age groups. LDL-C levels across the follow up time were calculated. Cox regression models were used to assess HRs (Hazard Ratios) for repeat ASCVD event (MI and stroke/TIA) and all cause death, stratified by age and GDSI treatment.

Results: Over ~5y follow up, amongst adults aged>75 years (n=11,596), less than half (49.6%) were on GDSI and only ~54% older adults achieved LDL-c<70mg/dL. Compared to GDSI use, older adults on <GDSI had a greater incidence of recurrent MI [HR>75y 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 p<0.01 in <GDSI group vs GDSI group. GDSI use had a greater reduction of MI and mortality in older adults than younger counterparts [Table 1].

Conclusions: In this contemporary healthcare network, GDSI use for secondary prevention and LDL-C<70 mg/dL was suboptimal amongst all age groups. Any statin use conferred a greater reduction in MI and mortality amongst older adults >75y. Systemic interventions for guideline implementation and optimal statin use in older adults with ASCVD should be explored further.