Age No Barrier: LDL Cholesterol Reduction Effective in Preventing CVD among elderly

 A groundbreaking study conducted in Denmark has provided compelling evidence that lowering low-density lipoprotein (LDL) cholesterol through lipid-lowering therapy can significantly reduce the risk of cardiovascular disease, regardless of age. While prior research has consistently shown the benefits of this approach for individuals under 70, this study delves into the effectiveness of the treatment for those aged 70 and older.

The study results were published in the Journal of the American College of Cardiology. 

Cardiovascular diseases are a global health burden. Low-density lipoproteins are the major cause of increased risk of cardiovascular diseases and stroke and hence managing the levels is of utmost importance. Previous literature shows that lowering LDL levels reduces the risk of cardiovascular diseases in younger individuals aged <70 years of age. There is uncertainty about its effect on individuals aged >70 years of age. Hence Danish researchers conducted a Nationwide cohort study to to compare the clinical impact of reducing LDL cholesterol using lipid-lowering therapy as a primary prevention measure against cardiovascular disease in both older and younger individuals. 

The researchers included individuals aged 50 and above who had commenced lipid-lowering therapy between January 1, 2008, and October 31, 2017. Importantly, these participants had no history of atherosclerotic cardiovascular disease and had both baseline and within-one-year LDL cholesterol measurements available. The associated risk of major vascular events among older individuals (≥70 years) by HRs per 1 mmol/L reduction in LDL cholesterol compared with younger individuals was also assessed. The results of this extensive study, which included 16,035 older individuals (aged 70 and above) and 49,155 younger individuals (under 70), were striking. 

The results: 

• In both age groups, the median reduction in LDL cholesterol was approximately 1.7 mmol/L.
• What was particularly noteworthy is that for older individuals, every 1 mmol/L reduction in LDL cholesterol corresponded to a remarkable 23% lower risk of experiencing major vascular events. 
• This risk reduction in older individuals was almost identical to that observed in their younger counterparts.
• The hazard ratio (HR) for older individuals was 0.77 (95% confidence interval: 0.71-0.83), while for younger individuals, it was 0.76 (95% confidence interval: 0.71-0.80).
• Notably, the statistical analysis found no significant difference between the two age groups, with a p-value difference of 0.79.

The study's conclusions underscore the importance of ongoing research in the field of cardiovascular health and primary prevention strategies. The clinical benefits of reducing LDL cholesterol as a primary preventive measure for major vascular events are just as significant for individuals aged 70 and above as they are for those under 70, signifying that age should not be a barrier to this potentially life-saving therapy. As the global population continues to age, understanding how different age groups respond to interventions like lipid-lowering therapy becomes increasingly crucial. This Danish study, with its robust methodology and compelling results, represents a significant step forward in our knowledge of cardiovascular disease prevention and treatment across the lifespan. 

Further reading: LDL-C Reduction With Lipid-Lowering Therapy for Primary Prevention of Major Vascular Events Among Older Individuals. https://doi.org/10.1016/j.jacc.2023.07.027