Russian Journal of Cardiology · Apr 22, 2026

Using artificial intelligence technologies for phenotyping and optimization of combination lipid-lowering therapy in elderly patients with atherosclerosis (PHOENIX Study)

By Zolotovskaya IA, Duplyakov DV, Shatskaya PR

Aim . To evaluate the potential of artificial intelligence (AI) technologies as a "second pilot" tool for phenotyping elderly patients with atherosclerosis in various vascular systems and to study the clinical efficacy of combination lipid-lowering therapy (rosuvastatin + ezetimibe) in this population. Material and methods. This prospective cohort study included 739 patients over 60 years of age (median, 67 [63; 72] years; women, 52,8%) with verified atherosclerosis (coronary, cerebral, or peripheral arteries). Using stratified randomization, patients were divided into two following groups: the main group (n=371) received combination therapy (rosuvastatin 20 mg + ezetimibe 10 mg/day) for 6 months; the control group (n=368) received standard lipid-lowering therapy (rosuvastatin 20 mg/day) in accordance with clinical guidelines. A machine learning algorithm (gradient boosting with SHAP-based interpretation) integrated into the clinical decision support system was used for patient phenotyping. Lipid profile, echocardiographic parameters, and changes in comorbid pathology were assessed at the baseline visit and after 3and 6-month follow-up. R e sults . The AI algorithm allowed us to identify four following clinical phenotypes of patients with atherosclerosis: "coronary" (38,2%), "cerebrovascular" (27,6%), "multifocal" (19,1%), and "metabolic" (15,1%). In the study group, significant lipid profile improvement was recorded by the 6th month of follow-up as follows: a 54,2% decrease in low-density lipoprotein cholesterol (LDL-C) (p<0,001 vs control) and an 18,4% increase in HDL-C (p<0,01). Achievement of the target LDL-C level <1,4 mmol/L was observed in 67,4% of patients in the study group compared to 41,2% in the control group (p<0,001). Echocardiography data showed a 5,2% increase in left ventricular ejection fraction (p<0,01) and diastolic function improvement in the study group. The greatest treatment efficacy was observed in patients with the "coronary" and "multifocal" phenotypes. Conclusion . The use of AI as a "second pilot" allows for therapeutic strategy personalization in elderly patients with atherosclerosis. Combination therapy with rosuvastatin and ezetimibe demonstrates high efficacy in achieving target lipid levels and positive dynamics in echocardiographic parameters, with the greatest effect in certain clinical phenotypes.

doi.org/10.15829/10.15829/1560-4071-2026-6874 Open access Interventions