LDL-C reduction after initiation of Statins more pronounced in older people than younger persons

USA: A recent study showed a greater reduction in LDL cholesterol levels in older persons treated with low- to moderate-intensity statins as compared to younger people. Therefore, statins may be more appealing as initial treatment for the elderly at increased risk for adverse events. 

The study of more than 80,000 persons, published in the Annals of Internal Medicine, found that age is a significant independent predictor of low-density lipoprotein cholesterol (LDL-C) response to statin treatment initiation.

The initiation of low- to moderate-intensity statins was associated with a greater reduction of LDL-C in older persons than younger persons, regardless of whether the statin was prescribed for primary prevention, for secondary prevention, or among patients with diabetes. 

Patient-to-patient LDL-C response varies widely in statin treatment. The reduction in LDL-C may depend on the age of the patient treated. Persons older than 75 years have been underrepresented in randomized clinical trials, which limits evidence about the effects of statin treatment in this age group. While current guidelines recommend statin use for secondary prevention in older adults, the recommendation is less strong for primary prevention.

Researchers from Statens Serum Institut, the Danish Cancer Society Research Center, Copenhagen University Hospital-Bisbebjerg and Frederiksberg and Stanford University conducted a nationwide cohort study of 82,958 persons initiating simvastatin or atorvastatin, including 10,388 persons aged 75 years and older. The authors found that initiators aged 75 years or older had higher mean LDL-C percentage reductions than initiators younger than 50 years.

For example, they note that older persons initiating 20 mg simvastatin experienced a mean reduction of 39.0 percent compared with younger persons, who only experienced a mean reduction of 33.8 percent. Similarly, older persons initiating 20 mg atorvastatin experienced a mean reduction of 44.2 percent compared with younger persons, who experienced a mean reduction of 40.2 percent. According to the study authors, these findings suggest that low- to moderate statins may be more appealing as initial treatment in older adults who are at increased risk for adverse events. 

Reference:

Giulia Corn, Mads Melbye, Mark A. Hlatky, Jan Wohlfahrt, DrMedSci, and Marie Lund, Association Between Age and Low-Density Lipoprotein Cholesterol Response to Statins, https://doi.org/10.7326/M22-2643.