Cholesterol Lowering Treatments Reduce the Risk of Cardiovascular Events

Børge Nordestgaard

In a pair of new studies, investigators found low-density lipoprotein cholesterol lowering medications can benefit geriatric patients by reducing the risk of cardiovascular events.

Researchers provided new evidence on whether low-density lipoprotein cholesterol lowering therapies, including statins, could reduce the rate of major cardiovascular events in older patients.

High levels of LDL cholesterol could lead to the narrowing of blood vessels, which makes it more likely a person will suffer a heart attack or a stroke.

In the observational study, the researchers found individuals who have not had a previous cardiovascular event between 70-100 gain more benefit from taking medications to lower cholesterol compared to younger age groups, in terms of the number of heart attacks and cardiovascular events that might be prevented per person treated.

In the study, the investigators examined data from more than 90,000 individuals in Denmark, including 13,779 patients between 70-100 years old. The patients were followed for an average of 7.7 years, with the number of first-time heart attacks and cases of cardiovascular disease, as well as LDL cholesterol levels, recorded for each individual.

The researchers also evaluated the potential benefit of statins for each age group by estimating the number of people who need to be treated with a moderate-intensity statin therapy to prevent 1 incidence of heart attack in 5 years.

Overall, patients over the age of 70 had the highest incidence of heart attack and cardiovascular disease of any of the age groups (heart attacks per 1000 people per year irrespective of LDL cholesterol levels: Age 80-100, 8.5; age 70-79, 5.2; age 60-69, 2.5; age 50-59, 1.8; age 20-49, 0.8).

This shows that people aged 80-100 years suffered 8.5 heart attacks per 1000 people each year.

The researchers also estimated that the number of older people who need to receive a moderate-intensity statin therapy to prevent 1 heart attack in 5 years is fewer than for the younger age groups in the study.

The study included a total of 1515 incidences of a first-time heart attack and 3389 cases of cardiovascular disease.

In addition, the investigators found 1 heart attack could be prevented for every 80 people between 80-100 years old that is treated. For individuals between 50-59 years old, 439 patients would need to be treated to prevent 1 incidence of a heart attack.

“Our study provides further evidence for the cumulative burden of LDL cholesterol over a person’s lifetime and the progressive increase in risk for heart attack and cardiovascular disease with age,” Børge Nordestgaard, joint author of the first study, of the Copenhagen University Hospital, said in a statement. “With the proportion of people living beyond 70 years of age worldwide rapidly increasing, these data point to the huge potential for primary prevention strategies aimed at lowering LDL cholesterol levels to reduce the population burden of heart disease. The findings should guide decision making about whether older individuals will benefit from statin therapy.”

In the separate systematic review and meta-analysis, the investigators found cholesterol-lowering therapies are as effective at reducing cardiovascular events in patients at least 75 years as they are in younger patients. After examining data from 29 randomized controlled trials involving more than 21,000 patients at least 75 years old, the investigators found cholesterol-lowering medications reduced the relative risk of major vascular events in older patients by 26% per 1 mmo/L reduction in LDL cholesterol.

These results are comparable to the risk reeducation in patients younger than 75 years old (15% per 1mmo/L reduction in LDL cholesterol). The incidence of heart attacks also decreased in this age group.

The study, “Older adults are at greater risk of cardiovascular events than younger people, and benefit at least as much from cholesterol-lowering medications, two studies suggest,” was published online in The Lancet.