LDL-C Lowering Therapy Beneficial in Elderly Populations

Baris Gencer, MD

Findings from a new study concluded that lipid-lowering lowering therapy is as effective in patients ≥75 years of age as in younger adults.

The study and its findings are a response to the ongoing debate surrounding the clinical benefit of LDL-C lowering therapy in eldery patients.

A team, led by Baris Gencer, MD, Cardiology Division, Geneva University Hospitals, used the Medline database to pool data from across 29 studies between the years 2015-2020. They only included randomized controlled cardiovascular outcome trials which tested a particular LDL-C therapy and which had data available for patients ≥75 years at randomization.

“For efficacy, we meta-analyzed the risk ratio (RR) of major vascular events (a composite of cardiovascular (CV) death, myocardial infarction, stroke or coronary revascularization) per 1-mmol/L reduction in LDL-C,” they wrote.

Among the 244,090 patients across all trials, 8.8% were considered part of the elderly population. Further, 11,750 patients were part of statin trials, 6209 were from ezetimibe trials, and 3533 were from PCSK9 inhibitor trials.

The investigators noted that the median follow-up ranged from 2.2-6.0 years.

Results of their analysis showed that LDL-C therapy significantly reduced major vascular events (n = 3519) for them by 26% per 1-mmol/L LDL-C reduction (RR, 0.75; 95% CI, 0.61-0.89); P .002).

They compared these findings to the effect noted in the non-elderly population (RR, 0.85; 95% CI, 0.78-0.92;P = 0.24). Thus, Gencer and colleagues suggested a similar level of effect between the age populations.

They also found that the response rate was virtually similar between statin therapy (0.81; 95% CI, 0.70-0.94) and non-statin therapy (0.61; 95% CI, 0.47-0.95; P = 0.60).

The broken-down composite results showed that LDL-C lowering had a beneficial effect in relation to cardiovascular death (RR, 0.85; 95% CI, 0.73-0.996; P = .045), myocardial infarction (RR, 0.80; 95% CI, 0.70-0.92; P = 0.001), stroke (RR, 0.71; 95% CI, 0.58-0.87; P = 0.001), and coronary revascularization (RR, 0.78; 95% CI, 0.63-0.96; P = 0.017).

“In patients 75 years and older, lipid-lowering therapy is as effective in reducing CV events as it is in younger adults.” Gencer and team concluded. 

“These results should strengthen guideline recommendations for the use of lipid-lowering therapies, including non-statin therapy, in the elderly,” they said.

Recently, the US Departments of Veteran Affairs (VA) and Defense (DoD) released an update of their clinical practice guideline for the management of dyslipidemia in adults with cardiovascular disease risk.

The updated guidelines consisted of recommendations related to statin dose, additional risk prediction tests, as well as primary and secondary prevention measures, laboratory testing, and physician activity/nutrition.

Although similar to recommendations from the American College of Cardiology and American Heart Association, these guidelines—which were based on a systematic and comprehensive evaluation of the recent literature—also presented notable differences.

They were less confident in data supporting lower LDL-C target levels and higher dosing of statins, especially in primary prevention.

Further, they took a more assertive stance on the importance of aerobic activity, cardiac rehabilitation, nutrition, and supplements.

The study, “Efficacy of Lowering Low-density Lipoprotein Cholesterol in Elderly Subjects: A Systematic Review and Meta-analysis of Randomized Controlled Trials,” was published online in Circulation.