The following is a summary of “Combination Moderate-Intensity Statin and Ezetimibe Therapy for Elderly Patients With Atherosclerosis,” published in the April 2023 issue of Cardiology by Lee, et al.
Due to the increased risk of intolerance or adverse events in elderly patients, caution is required when considering the routine use of high-intensity statins. For a study, researchers sought to assess the impact of combining a moderate-intensity statin with ezetimibe therapy compared to high-intensity statin monotherapy in elderly patients with atherosclerotic cardiovascular disease (ASCVD).
In the post hoc analysis of the RACING trial (RAndomized Comparison of Efficacy and Safety of Lipid-lowerING With Statin Monotherapy Versus Statin/Ezetimibe Combination for High-risk Cardiovascular Diseases), patients were stratified by age (≥75 years and <75 years). The primary endpoint was a composite of cardiovascular death, major cardiovascular events, or nonfatal stroke over a 3-year period.
Of the 3,780 enrolled patients, 574 (15.2%) were aged ≥75. Among patients aged ≥75 years, the rates of the primary endpoint did not differ significantly between the moderate-intensity statin with ezetimibe combination therapy group and the high-intensity statin monotherapy group (10.6% vs. 12.3%; HR: 0.87; 95% CI: 0.54-1.42; P = 0.581). Similarly, among patients aged <75 years, there was no significant difference in the rates of the primary endpoint between the two groups (8.8% vs. 9.4%; HR: 0.94; 95% CI: 0.74-1.18; P = 0.570) (P for interaction = 0.797). However, moderate-intensity statin with ezetimibe combination therapy was associated with lower rates of intolerance-related drug discontinuation or dose reduction in both the ≥75 years age group (2.3% vs. 7.2%; P = 0.010) and the <75 years age group (5.2% vs. 8.4%; P < 0.001) (P for interaction = 0.159).
In elderly patients with atherosclerotic cardiovascular disease, moderate-intensity statin with ezetimibe combination therapy demonstrated similar cardiovascular benefits to high-intensity statin monotherapy while also reducing the rates of intolerance-related drug discontinuation or dose reduction. The combination therapy may be a viable alternative for elderly patients at higher risk of intolerance or adverse events associated with high-intensity statin monotherapy.