Age-stratified LDL trends and lipid-lowering therapy gaps in women undergoing cardiac catheterization
E Carrion, Y Feng, N Procopi, S Sartori, A Oliva, K Hemelrijk, V Raona, V Kapur, A Hooda, P R Moreno, J M Sweeny, G D Dangas, A S Kini, S K Sharma, R MehranAbstract
Background
The burden of cardiovascular diseases among young women is rising despite advancements in pharmacological therapies. Emerging evidence suggests that lifelong atherogenic burden and persistent undertreatment of younger women contribute to this trend. Conventional prediction tools often classify younger women as low risk, resulting in delayed initiation of adequate lipid-lowering therapy (LLT) despite elevated LDL-C levels. Whether these gaps translate into real-world differences at the time of coronary intervention remains insufficiently characterised.
Purpose
To evaluate age-related differences in LDL burden, LLT utilisation, and temporal trends among women undergoing percutaneous coronary intervention (PCI).
Methods
We retrospectively analysed women undergoing PCI between 2012 and 2024 from a large contemporary PCI registry. Patients were stratified by age (18–54, 55–65, and 66–85 years). LDL control was defined according to American guideline-recommended targets (LDL-C <70 mg/dL). Age-stratified LDL-C distributions, temporal trends, and LLT utilisation at admission and discharge were assessed.
Results
Among 6,910 women undergoing PCI, 753 were aged 18-54 (10.9%), 1892 aged 55-65 (27.4%) and 4265 aged 66-85 (61.7%). Younger women had a higher prevalence of family history of coronary artery disease and presentation of myocardial infarction [OA1] (25.4% and 21.4%, respectively). The baseline LDL-C control differed significantly across age groups (p < 0.001) (Figure 1); proportions of LDL-C < 70 mg/dL increased gradually with age, occurring in 28.4% of women aged 18–54 years, 34.0% of those aged 55–65 years, and 39.4% of those aged 66–85 years. Although the prevalence of LDL-C ≥70 mg/dL decreased over time, younger women consistently exhibited the highest rates of uncontrolled LDL throughout the study period. LLT use at admission was significantly lower in younger women (72.6% vs older women 76.4% and 79.0%: p < 0.001). Temporal analyses demonstrated increasing LLT use at admission across age groups, with significant upward trends observed in women aged 55–65 years (p=0.0139) and 66–85 years (p=0.0231) (Figure 2). Despite overall improvement, younger women remained consistently less likely to receive LLT throughout the study period (p=0.9712) (Figure 2).
Conclusions
Despite improvements in lipid management over time, younger women remain disproportionately undertreated and present with higher uncontrolled LDL-C levels at the time of PCI. These findings underscore persistent prevention gaps and emphasise the need for earlier and more proactive LLT strategies in women.Figure 1Figure 2