Suboptimal Achievement of Guideline-Recommended LDL-C Targets in Older Patients Undergoing Comprehensive Geriatric Care

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Background: Lowering low-density lipoprotein cholesterol (LDL-C) effectively reduces the risk of cardiovascular events. Therefore, we investigated LDL-C levels in geriatric patients undergoing comprehensive inpatient geriatric care. Methods: Patients aged ≥65 years who underwent inpatient comprehensive geriatric care were analyzed. Baseline, clinical, laboratory, and medical data were obtained from case records. For cardiovascular risk stratification, SCORE2, SCORE2-OP, or SMART2 was applied, and LDL-C targets for primary or secondary prevention of atherosclerotic cardiovascular disease (ASCVD) were defined. Factors associated with LDL-C values within guideline-recommended targets in the univariate analysis were entered into a logistic regression model to identify independent predictors. Results: Of 486 patients, 433 (median age 84.0 years; 67.2% female) were included in the final analysis. The majority of patients (371/433; 85.7%) had a very high cardiovascular risk profile. Lipid-lowering therapy (LLT) was identified in 222 patients (51.3%), while 205 patients (47.3%) had received LLT for ≥3 months. In 219 patients (98.7%), LLT was statin-based, either as monotherapy or in combination. The median LDL-C level in the entire cohort was 85 mg/dL (IQR: 63–114 mg/dL), whereas patients receiving LLT had a median LDL-C level of 66 mg/dL (IQR: 52–83 mg/dL). Overall, 193 patients (44.6%) achieved guideline-recommended LDL-C targets; among patients receiving LLT, 61.5% (126/205) were within target range. Intake of ≥5 medications per day was associated with pre-existing LLT (odds ratio: 3.036; 95% CI: 1.081–8.523; p = 0.035). Statin-based LLT was independently associated with achieving LDL-C targets (odds ratio: 3.383; 95% CI: 2.248–5.092; p < 0.001). Conclusions: Most patients did not achieve guideline-recommended LDL-C targets, while only half received lipid-lowering therapy, predominantly statin-based. Current risk assessment tools and approaches to polypharmacy may require adaptation for geriatric patients. Nevertheless, even the simple implementation of statin therapy alone could substantially improve cardiovascular preventive care in a large proportion of untreated older patients.

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