{
  "abstract": "Background The risk of recurrent events and cardiovascular death following a diagnosis of coronary artery disease (CAD) is higher in older adults. We aimed to compare and contrast the attainment of guideline-directed secondary prevention dyslipidaemia targets in older patients in order to identify targetable pitfalls in their management and improve outcomes.Methods We conducted a secondary analysis of the iASPIRE study which examined secondary prevention outcomes in patients following a CAD event in Ireland.Results 720 patients were examined with a mean age (SD) of 63.9 years (± 8.9 years) and female patients representing 28.6% (n=134) of all patients ( table 1). 202 patients (28.1%) were above 70 years of age. 52.5% (n=106) of older adults were enrolled following elective revascularisation. Older patients had a lower mean LDL-C of 2.37 mmol/L (±1) versus 2.91 (±1.09) for their younger counterparts(p≤0.001) and a higher rate of statin use prior to their event at 53.6% vs 40%(p=0.005). At follow-up, there was no significant difference in the attainment rate of ESC LDL-C prevention targets with 35.1% of younger patients versus 39.6% of older patients reaching an LDL-C ≤1.8mmol/L (p=0.87) and a mean LDL-C of 2.06 (±0.68) and 2.03 (±0.67) for the younger and older groups respectively (p=0.60) (table 2). Older adults were 36% less likely to be on a high-intensity statin and only 2 older patients were prescribed ezetimibe.Conclusion Achievement of secondary prevention targets is low in older patients following a CAD event. Two major targetable pitfalls are the intensification of statin therapy and the use of add-on therapies in the older population. Future research needs to be more inclusive to gain a better insight into the safety and efficacy of lipid-lowering therapies amongst older adults.Abstract 55 Table 1Characteristics at time of index of event, level of significance set at p<0.05 Characteristics All patients n= 720 <70 years of age n= 518 ≥70 years of age n= 202 p-value Age – mean (SD) 63.9 (8.87) - - - Gender, n (%)FemaleMale 134 (18.6)586 (81.4) 89 (17.2)429 (82.8) 45 (22.3)157 (77.7) 0.114 Education, n (%)No schooling or less than primary schoolPrimary schoolSecondary school or equivalentThird-level degree or beyond 19 (2.6)268 (37.2)280 (38.8)149 (20.7) 9 (1.7)162 (31.4)228 (44.2) 117 (22.7) 10 (5)106 (53)52 (26)41.6 (16) <0.001 BMI, n (%)UnderweightNormalOverweightObese 2 (0.3)107 (14.9)328 (45.7)280 (39.1) 1 (0.2)70 (13.5)229 (44.3)217 (42) 1 (0.5)37 (18.5)99 (49.5)63 (31.5) 0.051 Presentation, n (%)ACSCCS 399 (55.3)322 (44.7) 303 (58.4)216 (41.6) 96 (47.5)106 (52.5) 0.008 Dyslipidaemia prior to index event, n (%) 344 (62.1) 242 (60.8) 102 (65.4) 0.318 Statin use prior to index event, n (%) 281 (43.9) 183 (40) 98 (53.6) 0.005 LDL at time of discharge in mmol/L, mean (SD) 2.79 (1.09) 2.91 (1.09) 2.37(0.998) <0.001 Hypertension prior to index event, n (%) 349 (59.8) 223 (53.7) 126 (74.6) <0.001 Diabetes prior to index event, n (%) 93 (16.3) 64 (15.3) 29 (18.8) 0.317 Smoking status prior to index event, n (%)CurrentEx-smokerNever 97 (17)339 (59.3)136 (23.8) 85 (20.4)235 (56.4)97 (23.3) 12 (7.7)104 (67.1)39 (25.2) 0.001 Abstract 55 Table 2Outcomes on the management of dyslipidaemia at follow-up, level of significance set at p<0.05 All patients <70 years of age ≥70 years of age Mean difference (95% CI ) p-value LDL at follow-up in mmol/L, mean (SD) 2.05 (0.68) 2.06 (0.68) 2.03 (0.67) 0.3 (-0.08 –0.14) 0.596 LDL reduction in mmol/L, mean (SD) 0.79 (1.18) 0.92 (1.17) 0.35 (1.09) 0.57 (0.28–0.86) <0.001 Odds ratio (95% CI) LDL <1.4 mmol/L, n (%) 94 (13) 67 (12.9) 27 (13.4) 1.041 (0.64–1.68) 0.870 LDL <1.8 mmol/L, n (%) 262 (36.3) 182 (35.1) 80 (39.6) 1.21 (0.87–1.7) 0.255 On any statin, n (%) 576 (80.9) 415 (80.9) 161 (80.9) 1.01 (0.64–1.57) 0.998 On ezetimibe, n (%) 27 (3.9) 23 (4.6) 4 (2) 0.320 On high-intensity statin, n (%) 415 (60.1) 314 (63.1) 101 (52.3) 0.64 (0.46–0.9) 0.01",
  "authors": [
    {
      "affiliations": [
        "University of Galway, Galway, Ireland",
        "University Hospital Waterford, Waterford, Ireland"
      ],
      "name": "PJ Smyth"
    },
    {
      "affiliations": [
        "University Hospital Waterford, Waterford, Ireland"
      ],
      "name": "M Killian"
    },
    {
      "affiliations": [
        "University of Galway, Galway, Ireland",
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland"
      ],
      "name": "DA Wood"
    },
    {
      "affiliations": [
        "University of Galway, Galway, Ireland",
        "National Institute for Prevention and Cardiovascular Health, Galway, Ireland"
      ],
      "name": "S Connolly"
    }
  ],
  "title": "55 Pharmacological management of dyslipidaemia and achievement of secondary prevention lipid targets in older adults (≥70 years) following a CAD event: secondary analysis of the iASPIRE study",
  "uid": "22cfdd79-6be9-5b04-ae06-6c1dda152969"
}