TOPLINE:
Patients older than age 70 years have a 23% lower risk of a first major vascular events with each 1 mmol/L lowering of low-density lipoprotein (LDL) cholesterol, which is similar to the benefit seen among younger patients in primary prevention, new research shows.
METHODOLOGY:
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Using various cross-linked Danish registries, researchers analyzed 65,190 participants aged 50 years and older (49,155 aged 50-69 and 16,035 aged 70+) without a history of atherosclerotic cardiovascular disease (ASCVD) who initiated new lipid-lowering treatment and had a baseline LDL cholesterol measurement and a subsequent measurement within a year.
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The primary outcome was hospitalization for a major vascular event, defined as a composite of acute coronary syndrome, non-hemorrhagic stroke, and coronary revascularization. Secondary outcomes included individual cardiovascular components of the primary outcome and all-cause mortality.
TAKEAWAY:
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During a median follow-up of 2.5 years, 626 older (70 years and over) and 1123 younger (aged 50-69) participants had a major vascular event, with crude incidence rates of 13.4 and 7.1 per 1000 person-years, respectively.
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After adjusting for potential confounders, each 1 mmol/L reduction in LDL cholesterol in people aged 70 and older was associated with a significant 23% lower risk for major vascular events (hazard ratio [HR] 0.77; 95% CI, 0.71 – 0.83), similar to results for those younger than 70 (HR, 0.76; 95% CI, 0.71 – 0.80; P value for the difference between the age groups, 0.79).
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Results across all cardiovascular secondary analyses supported the main findings, and there was no significant difference between older and younger participants across all subgroup analyses, including using 75 years as the age cutoff.
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There was no association with all-cause mortality for either the older (HR, 1.03; 95% CI, 0.98 – 1.09) or younger (HR, 1.00; 95% CI, 0.95 – 1.06) groups.
IN PRACTICE:
“Our results, based on a substantial sample size representative of a contemporary general population, may contribute to informing future guideline recommendations,” and to discussions with older patients about the benefits of LDL lowering therapy, the authors write. They stress any potential benefits should be balanced against potential harms in this population, as these individuals may have comorbidities and may be taking multiple medications.
In an accompanying editorial, Safi U. Khan, MD, from the Department of Cardiology at Houston Methodist DeBakey Heart and Vascular Center, said the study “contributes valuable insights regarding the effects of LDL-C-lowering therapy, especially as the burgeoning aging population faces escalating burden of ASCVD,” and added future research “should focus on corroborating these findings and addressing the safety of lipid-lowering treatments in older individuals.”
SOURCE:
The study was conducted by Niklas Worm Andersson, MD, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark, and colleagues. It was published online September 25 in the Journal of the American College of Cardiology.
LIMITATIONS:
The results may not apply to individuals without LDL monitoring when receiving lipid-lowering treatment. Outcomes relied on the validity of recorded diagnostic codes in the registries, and medical record review of cases was not done. Residual confounding can’t be ruled out, in part because data on potentially important risk factors such as smoking, blood pressure, and body mass index weren’t available. The results may not generalize to clinical scenarios or subpopulations not directly studied.
DISCLOSURES:
Andersson has no relevant conflicts of interest. Author Tine Lovsø Dohlmann, PhD, was employed by Statens Serum Institut during the study, but has been employed by Novo Nordisk A/S, Søborg, Denmark since January 2023. All other study authors and the editorialist Khan have no relevant conflicts of interest.
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