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Is Age a Factor in Clinical Effectiveness of Lipid-Lowering Therapy For CVD Prevention?

The clinical effectiveness of lowering LDL-C with lipid-lowering therapy (LLT) for primary prevention of atherosclerotic cardiovascular disease (ASCVD) was similar among individuals younger and older than 70 years, according to a cohort study published Oct. 3 in JACC.

Niklas Worm Andersson, et al., conducted a Danish nationwide cohort study that included individuals aged ≥50 years who had initiated LLT (statins alone or in combination) between Jan. 1, 2008 and Oct. 31, 2017, who had no history of ASCVD (no hospitalization for ASCVD, use of nitrates, adenosine diphosphate inhibitors or drugs used for secondary prevention), and who had LDL-C measured at baseline and within one year. They examined the associated risk of major vascular events among older individuals (≥70 years; n=16,035) by hazard ratios (HRs) per 1 mmol/L reduction in LDL-C compared with younger individuals (<70 years; n=49,155).

Results showed that the median LDL-C reduction was 1.7 mmol/L for both older and younger individuals. Notably, in both groups, each 1 mmol/L reduction in LDL-C was significantly associated with a lower risk of major vascular events to a similar degree (HR, 0.77; 95% CI, 0.71-0.83 in older and HR, 0.76; 95% CI, 0.71-0.80 in younger individuals; p-value for difference 0.79). Similar results were observed across all secondary analyses.

Of note, the study included only new users of LLT in routine clinical practice. “Evidence from clinical trials of treatments lowering LDL-C has shown that the relative risk of major vascular events is reduced by about 20% for each 1 mmol/L (~40 mg/dL) lowering of LDL-C, which is remarkably similar with the 23% lowering in this Danish population study,” writes Melvyn Rubenfire, MD, FACC, on Interestingly, he adds, the frequency of the physicians prescribing low-, moderate- and high-intensity LLT was similar in older and younger groups. Among the limitations includes the likelihood that a significant percentage of those defined as primary prevention had ASCVD.

The authors write, “Based on a general population sample and data derived from routine contemporary clinical practice, these results support the clinical benefit of lowering LDL-C for primary prevention in older individuals and may contribute to informing guideline recommendations, clinician-patient discussion, and health care policies.”

In an accompanying editorial comment, Safi U. Khan, MD, MS, writes that “the study by Andersson, et al., contributes valuable insights regarding the effects of LDL-C–lowering therapy, especially as the burgeoning aging population faces an escalating burden of ASCVD. As we move forward, the research agenda should focus on corroborating these findings and addressing the safety of lipid-lowering treatments in older individuals. Hopefully, the ongoing randomized controlled trial STAREE (A Clinical Trial of Statin Therapy for Reducing Events in the Elderly; NCT02099123), which is comparing statin with placebo in more than 18,000 patients aged ≥70 years without ASCVD, will yield further insights.”

Clinical Topics: Dyslipidemia, Nonstatins, Novel Agents, Statins

Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cohort Studies, Cardiovascular Diseases, Adenosine Diphosphate, Atherosclerosis

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