ArticleFrontiers in pharmacology2025
Predictors and benefits of lipid-lowering therapy initiation after an atherosclerotic cardiovascular event: a retrospective cohort study.
Article in Frontiers in pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Guidelines recommend lipid-lowering therapy (LLT) after an atherosclerotic cardiovascular disease (ASCVD) event. This study investigated real-world LLT initiation rate and its effect on total mortality in the Lombardy region. Methods: Individuals aged ≥40 with an ASCVD event between January and September 2022 were identified from Lombardy's administrative data. The prevalence of LLT initiation within 3 months was estimated, and factors influencing treatment initiation were evaluated using multivariate logistic regression (odds ratios [OR] and 95% confidence intervals [95% CI]). One-year post-event mortality was analyzed. Results: Among 16,025 patients 41.14% did not receive a LLT after an ASCVD event. Treatment initiation was more likely in subjects hospitalized for a cardiovascular event (OR 2.22, 95%CI 2.07-2.38, vs. cerebrovascular event), in patients aged 51-60 years (OR 1.30, 95%CI 1.16-1.46), and in patients previously treated with antidiabetic (OR 1.42, 95%CI 1.25-1.62), antihypertensive (OR 1.96, 95%CI 1.80-2.13), and thyroid hormone replacement medications (OR 1.34, 95%CI 1.10-1.63). Conversely, older age (71-80 years: OR 0.79, 95%CI 0.71-0.87; >80 years: OR 0.47, 95%CI 0.42-0.52), female sex (OR 0.73, 95%CI 0.68-0.79), previous exposure to antithrombotic medications (OR 0.65, 95%CI 0.59-0.72), and polypharmacy (OR 0.90, 95%CI 0.81-0.99 for 5-9 medications, OR 0.61, 95%CI 0.52-0.72 for ≥10 medications) reduced the likelihood of treatment. Mortality at 1 year was 3.07% in treated versus 11.66% in untreated patients (p-value <0.001). Conclusion: This study underscores a suboptimal LLT initiation rate in post-ASCVD patients. Initiating LLT is associated with significantly reduced 1-year total mortality, highlighting the need to optimize secondary prevention strategies.
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