European Primary Care Cardiovascular Society

Elderly people also benefit from lipid-lowering therapy for primary prevention

LDL-C Reduction With Lipid-Lowering Therapy for Primary Prevention of Major Vascular Events Among Older Individuals

Literature - Andersson NW, Corn G, Dohlmann TL, et al. - J Am Coll Cardiol. 2023 Oct 3;82(14):1381-1391. doi: 10.1016/j.jacc.2023.07.027

Introduction and methods

Background

In elderly people, there is a lack of evidence for the clinical benefit of LDL-c reduction with lipid-lowering therapy for primary prevention [1-4], in part due to underrepresentation of this population in the relevant clinical trials [3,4]. Hence, American and European guidelines provide only weak recommendations for considering initiating statins for primary prevention in older individuals [5,6].

Aim of the study

The authors compared the clinical effectiveness of LDL-c reduction associated with the initiation of lipid-lowering therapy for primary prevention of major vascular events among older and younger individuals in a Danish nationwide cohort.

Methods

Individual-level data were obtained from different Danish national health care and administrative registries to construct a nationwide cohort of individuals aged ≥50 years who initiated new use of lipid-lowering therapy (statins alone or in combination with other lipid-lowering drugs) for primary prevention (i.e., they had no history of ASCVD) between January 2008 and October 2017. All study participants underwent an LDL-c measurement at baseline (≤6 months of index date) and at follow-up (2 weeks to 1 year after index date).

The study cohort comprised 65,190 participants: 16,035 individuals were ≥70 years of age and 49,155 were aged <70 years. Median follow-up time was 2.5 years (IQR: 1.2–5.1).

Outcomes

The primary endpoint was hospitalization for a major vascular event, defined as a composite outcome of ACS, nonhemorrhagic stroke, or coronary revascularization. Secondary endpoints were the individual CV components of the primary endpoint and all-cause mortality.

Main results

Conclusion

This Danish nationwide cohort study showed similar relative clinical benefits of LDL-c reduction associated with the initiation of lipid-lowering therapy for primary prevention of CVD in individuals aged ≥70 years and those aged <70 years. Per 1 mmol/L LDL-c reduction, the risk of major vascular events decreased by 23% in the older age group.

The authors state that as their results are “[b]ased on a substantial sample size representative of a contemporary general population, [they] may contribute to informing future guideline recommendations and clinician-patient discussion on the clinical benefit observed from lowering LDL cholesterol among older individuals for primary prevention of CVD during routine clinical care.”

References

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Find this article online at J Am Coll Cardiol.

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