AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Lipid-Lowering Therapy and Competing Geriatric Conditions Under Updated Dyslipidemia Guidelines for Older Adults
By Mangalesh S, Arya Nezhad S, Akman Z et al.
Background: The 2026 AHA/ACC multisociety dyslipidemia guideline refines lipid-lowering therapy (LLT) decisions in adults older than 75 years by incorporating life expectancy, frailty, multimorbidity, polypharmacy, and functional status. The population-level frequency with which these decision contexts coexist with near-term mortality and geriatric complexity is uncertain. Research Question: We estimated near-term mortality and competing geriatric conditions across guideline-relevant LLT decision contexts, defined by LLT use and atherosclerotic cardiovascular disease (ASCVD) status, among U.S. adults aged 75 years or older. Methods: We analyzed National Health and Nutrition Examination Survey 2011-2016 data linked to National Death Index mortality follow-up (Figure 1). Older adults (>75 years) were classified into 4 baseline groups by LLT use and prior ASCVD. LLT was defined as statin, ezetimibe, or PCSK9 inhibitor use, and ASCVD was defined as self-reported coronary heart disease, angina, myocardial infarction, or stroke. Death within 2.5 years was used as a pragmatic, population-level marker of survival, based on the guideline’s time-to-benefit horizon for primary-prevention initiation. Death within 1 year was used to inform continuation/ deprescribing decisions. Geriatric conditions included functional limitation, frailty/pre-frailty, polypharmacy, and multimorbidity. The combined burden of geriatric conditions was summarized as >=2 conditions. Nationally representative estimates incorporated survey weights, strata, and primary sampling units. Results: The analytic sample included 1,457 older adults, representing 15.8 million (13.9-17.6) U.S. adults. Overall, 50.5% (47.0-54.0) were receiving LLT, 29.1% (26.2-32.2) had ASCVD, 4.8% (3.8-6.0) died within 1 year, 13.0% (11.3-15.0) died within 2.5 years, and 81.3% had >=2 geriatric conditions. In the potential primary-prevention initiation context, 6.4 million (5.5-7.3) older adults without ASCVD were not receiving LLT; 10.5% (8.2-13.4) died within 2.5 years, and 71.6% had >=2 geriatric conditions. In the primary-prevention continuation/deprescribing context, 4.7 million (4.0-5.5) LLT users had no ASCVD; 3.5% (2.1-6.0) died within 1 year and 84.8% had >=2 geriatric conditions (Figure 2). Among adults with ASCVD, >=2 geriatric conditions were present in 90.5% of LLT users and 92.0% of untreated adults; untreated adults with ASCVD had the highest mortality burden, with 27.6% dying within 2.5 years. Conclusion: In this nationally representative analysis, LLT decision contexts for older adults emphasized by the 2026 dyslipidemia guideline were common and frequently coincided with limited near-term survival and geriatric complexity. These findings quantify how often time-to-benefit and competing geriatric conditions occur in shared LLT decision-making in late life.