In patients aged ≥75 years, lipid-lowering was as effective in reducing cardiovascular events as it was in patients <75 years. These results from a systematic review and meta-analysis should strengthen guideline recommendations for the use of lipid-lowering therapies, including non-statin treatment, in older patients.
Data from 6 articles was included in the systematic review and meta-analysis, which included 24 trials from the Cholesterol Treatment Trialists’ Collaboration meta-analysis, in addition to 5 individual trials, presented by Dr. Baris Gencer (Brigham and Women’s Hospital, USA) [1,2].
The meta-analysis included a total of 244,090 patients from 29 trials, 21,492 (8.8%) of whom were aged at least 75 years. Of those, 11,750 (54.7%) were from statin trials, 6,209 (28.9%) from ezetimibe trials, and 3,533 (16.4%) from PCSK9 inhibitor trials. Median follow-up was between 2.2 years and 6.0 years.
The results showed that reducing LDL cholesterol significantly ameliorated the risk of major vascular events (n=3,519) in older patients by 26% per 1 mmol/L reduction in LDL cholesterol (RR 0.74; 95% CI 0.61–0.89; P=0.0019), with no statistically significant difference with the risk reduction in patients <75 years (RR 0.85; 95% CI 0.78–0.92; Pinteraction=0.37). Among older patients, relative risks were not statistically different for statin (RR 0.82; 95% CI 0.73–0.91) and non-statin treatment (RR 0.67; 95% CI 0.47–0.95; Pinteraction=0.64). The benefit of LDL cholesterol lowering in older patients was observed for each component of the composite, including cardiovascular death (RR 0.85; 95% CI 0.74–0.98), myocardial infarction (RR 0.80; 95% CI 0.71–0.90), stroke (RR 0.73; 95% CI 0.61–0.87), and coronary revascularisation (RR 0.80; 95% CI 0.66–0.96).
In conclusion, patients aged 75 years or older found that lipid-lowering therapies reduced the risk of major cardiovascular events in older patients just as much as they did in younger patients, with a 26% reduction in major cardiovascular events per 1 mmol/L reduction of LDL cholesterol.
- Gencer B, et al. Efficacy of Lowering Low-density Lipoprotein Cholesterol in Elderly Subjects: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Abstract 13787, Virtual AHA Scientific Sessions 2020, 13-17 Nov.
- Gencer B, et al. Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomized controlled trials. Lancet. 2020 Nov 9:S0140-6736(20)32332-1.