{
  "abstract": "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.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "name": "Leandro Cosco"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5wzw16ae45vfx.bib",
  "cited_by": 0,
  "doi": null,
  "fulltext_url": "https://www.btvb.org/btvb/article/view/725",
  "id": "5wzw16ae45vfx",
  "issns": [
    "2785-5309"
  ],
  "landing_url": "https://www.btvb.org/btvb/article/view/725",
  "language": "en",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC666-701"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-26",
  "publisher": "PAGEPress Publications",
  "ris": "https://research.draconitic.com/paper/5wzw16ae45vfx.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:47:29Z",
      "native_id": "59ae3426afd34b479bec5e6dc8dff86b",
      "source": "doaj",
      "url": "https://www.btvb.org/btvb/article/view/725"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC666-701",
      "subfield": "cardiovascular"
    }
  ],
  "title": "CO023 | STILL FAR FROM TARGET: REAL-WORLD LDL-CHOLESTEROL CONTROL, THERAPY USE, AND SEX DIFFERENCES IN TUSCANY",
  "title_text": "CO023 | STILL FAR FROM TARGET: REAL-WORLD LDL-CHOLESTEROL CONTROL, THERAPY USE, AND SEX DIFFERENCES IN TUSCANY",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:47:29Z",
  "url": "https://research.draconitic.com/paper/5wzw16ae45vfx",
  "venue": "Bleeding, Thrombosis and Vascular Biology",
  "versions": []
}