Older Patients Using Statins Could See Greater LDL-C Benefit than Younger Counterparts

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The magnitude of benefit obtained with statin therapy could be dependent on age at initiation, according to a new study from Denmark.

An analysis of a nationwide database with more than 80,000 statin initiators, results of the study provide evidence suggesting patients 75 years and older initiating statin therapy experienced a greater reduction in prestatin LDL-C level than their counterparts aged 50 years or younger.¹

“Low- to moderate-intensity statin therapy is associated with a greater LDL-C reduction in older than younger persons and may be more appealing as initial treatment in older adults who are at increased risk for adverse events,” wrote investigators.¹

Available at low-cost and with a safety and efficacy profile demonstrated through mountains of trials and other studies, statin therapy has developed a role for itself as a cornerstone in the management of cardiovascular risk for decades.² Citing a lack of older patients in clinical trials and previous studies purporting large patient-to-patient variability in LDL-C response to statin treatment based on age, investigators designed the current study to estimate associations between age and LDL-C reduction achieved with statin therapy using data from patients with a filled prescription with the Danish National Prescription Register from 2008 to 2018. Of note, the study was limited to prescriptions for simvastatin and atorvastatin, which accounted for more than 99% of initial statin prescriptions in Denmark during the study period.¹

With 2008 to 2018 as a period of interest, investigators identified 82,958 initiators of simvastatin or atorvastatin with LDL-C measurements prior to and during statin use for inclusion in their analyses. Among the 82,958 included in the study, 10,388 were aged 75 years or older. Investigators pointed out 34,876 participants had a history of cardiovascular disease, 6468 had a history of diabetes without cardiovascular disease, and 41,614 had neither cardiovascular disease nor diabetes.¹

The primary outcome of interest was the percentage reduction in prestatin LDL-C level and percentage reduction differences (PRDs) according to age and simvastatin or atorvastatin dose based on a longitudinal model for LDL-C. For the purpose of analysis, investigators established the following age groups for assessing LDL-C reduction: less than 50 years, 50-54 years, 55-59 years, 60-64 years, 65-69 years, 70-74 years, and 75 years or more.¹

Upon analysis, results provided evidence of a consistent trend with low- to moderate-intensity statin therapy, where initiators aged 75 years or older experienced greater LDL-C reductions than their counterparts aged younger than 50 years:¹

• 39.0% vs 33.8% for simvastatin 20 mg
• 44.2% vs 40.2% for atorvastatin 20 mg

Further analysis suggested the PRD for those aged 75 years or older relative to those aged 50 years was 2.62 percentage points. Additionally, investigators noted this association was consistent for both the primary (2.54 percentage points) and secondary prevention (2.32 percentage points) cohorts. analysis of primary . However, investigators pointed out a smaller effect was observed for initiators of high-intensity statin therapy (atorvastatin 40 mg: 1.36 percentage points; atorvastatin 80 mg: -0.58 percentage points).¹

“The principal finding of this study was that initiation of treatment with a low- to moderate-intensity statin was associated with a greater reduction in LDL-C levels among older patients than among younger patients,” investigators wrote.¹ “This association between age and statin response was found whether the statin was prescribed for primary prevention, for secondary prevention, or among patients with diabetes. Moreover, it was consistently found using several methods of analysis and alternative specifications of the study population.”

References:

1. _{^{Corn G, Melbye M, Hlatky MA, Wohlfahrt J, Lund M. Association Between Age and Low-Density Lipoprotein Cholesterol Response to Statins : A Danish Nationwide Cohort Study [published online ahead of print, 2023 Aug 1]. Ann Intern Med. 2023;10.7326/M22-2643. doi:10.7326/M22-2643}}
2. _{^{Campbell P. Rethinking statins: Time for primordial prevention? HCPLive. September 27, 2022. Accessed August 1, 2023. https://www.hcplive.com/view/rethinking-statins-time-for-primordial-prevention.}}