CO023 | STILL FAR FROM TARGET: REAL-WORLD LDL-CHOLESTEROL CONTROL, THERAPY USE, AND SEX DIFFERENCES IN TUSCANY

L. Cosco¹, M. Berteotti¹, F. Alfano¹, F. Profili², B. Nreu³, G. Casolo⁴, A. Zuppiroli⁵, E. Mannucci³, P. Francesconi², R. Marcucci¹ | ¹Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy; ²Epidemiology Unit, Regional Health Agency of Tuscany, Firenze, Italy; ³Diabetology Unit, Careggi University Hospital, Firenze, Italy; ⁴Cardiology Unit, Versilia Hospital, Lido di Camaiore, Italy; ⁵Former Department of Cardiology, Azienda Sanitaria di Firenze, Firenze, Italy

Background. Achieving low-density lipoprotein cholesterol (LDL-C) targets is a cornerstone of cardiovascular prevention, yet real-world data consistently show suboptimal control. We evaluated LDL-C target attainment, lipid-lowering therapy (LLT) use, adherence, and persistence in a large real-world population from Tuscany (Italy), with a specific focus on sex differences and temporal trends.
Methods. Administrative health databases and laboratory records were linked to identify individuals aged ≥45 years in Tuscany between 2019 and 2023. Patients were classified into cardiovascular risk categories according to contemporary European guidelines, with corresponding LDL-C targets. LDL-C target attainment, LLT consumption (expressed as defined daily doses, DDD/1,000 inhabitants/day), adherence, and 1-year persistence were analyzed overall, by risk class, and by sex.
Results. Among the Tuscan population, only 31% underwent at least one LDL-C measurement in 2023. Of 778,680 classified patients, 35.1% achieved their LDL-C target in 2023, compared with 11.6% in 2019–2021. Despite improvement, 64.9% remained above target, particularly in very high and extreme risk groups. LDL-C target attainment increased across all risk categories but remained low in very high-risk patients (22.7%). LLT consumption rose from 103 to 130.9 DDD/1,000 inhabitants/day between 2019 and 2023, driven mainly by increased use of statins, statin–ezetimibe combinations, and PCSK9 inhibitors. Adherence and persistence improved over time, with a reduction in low adherence (−9.2%) and an increase in high adherence (+5.2%). Women showed lower overall adherence than men but experienced the greatest improvement in adherence and 1-year persistence over time.
Conclusions. In this large real-world population, most individuals remain far from LDL-C targets despite encouraging temporal improvements. Increased LLT use, better adherence, and the introduction of combination therapy and PCSK9 inhibitors have contributed to progress. However, substantial gaps persist, particularly in high-risk patients and in women. Structured follow-up, early intensification of therapy, and targeted strategies to reduce sex disparities are essential to further improve LDL-C control.