Sex disparities in LDL-C target achievement among older adults receiving statin therapy

To evaluate sex differences in low-density lipoprotein cholesterol (LDL-C) target achievement among older Vietnamese adults receiving statin therapy for primary cardiovascular prevention and to assess the impact of the 2025 European Society of Cardiology (ESC) guideline updates on risk stratification and goal attainment.

This cross-sectional study enrolled 360 adults aged 70 years or older (median age 76 years; 47.8% female) receiving statin therapy for primary cardiovascular prevention at a tertiary hospital in Vietnam. Participants underwent comprehensive geriatric assessment, including frailty (Clinical Frailty Scale) and polypharmacy screening. Cardiovascular risk was classified using the Systematic COronary Risk Evaluation 2-Older Persons (SCORE2-OP) algorithm. LDL-C target achievement rates were compared between sexes using multivariable logistic regression, and the reclassification effects of the 2025 ESC guideline update were simulated relative to the 2021 guidelines.

Overall, 17.8% of participants achieved 2021 guideline-recommended LDL-C targets. Male sex was the strongest predictor of target achievement (adjusted odds ratio (aOR) = 2.64, 95% CI: 1.45–4.79, P = 0.001), persisting across all models. The 2025 ESC update reclassified 14.2% of participants to lower risk categories, increasing overall target achievement to 20.3% (P = 0.004). Frailty status was associated with differential benefit from the guideline update (interaction P = 0.002), with reclassification primarily benefiting non-frail adults. Neither frailty nor polypharmacy was independently associated with target non-attainment in multivariable analyses.

Fewer than one in five older Vietnamese adults achieve LDL-C goals, with a significant disparity disadvantaging women. While the 2025 ESC guideline update improves apparent achievement rates through risk reclassification, this benefit is unevenly distributed, favoring non-frail participants. Reducing this disparity will require sex-specific management strategies and intensified therapy regardless of frailty status.