Moderate-intensity statin and ezetimibe aid compliance in elderly atherosclerotic patients: Analysis of RACING Trial

Researchers found that patients aged 75 years and above taking a moderate-intensity statin with ezetimibe showed lower rates of drug discontinuation related to intolerance or dose reduction and lower rates of diabetes new-onset versus a course of high-intensity statins. The researchers reported their findings in a manuscript published Monday online and in the April 11 issue of the Journal of the American College of Cardiology.

Further, statin-related adverse events, such as liver enzyme elevation, new-onset diabetes, and muscle symptoms, were more familiar with high-intensity statins. New-onset diabetes is considered an independent risk factor for CV events.

The study by Sang-Hyup Lee, Yonsei University College of Medicine, South Korea, and the team included 574 patients with ASCVD aged 75 and older from the main RACING trial population. Compared with the rest of the trial population, patients in the elderly group are more likely to have lower BMI, be female and more likely to have a previous CABG history, cerebrovascular accident, and predisposing comorbidities like chronic kidney disease and hypertension.

The study led to the following findings:

• The rates of the primary endpoint—a 3-year composite of major cardiovascular events, cardiovascular death, or nonfatal stroke—in the elderly cohort were similar for those who received moderate-intensity statins with ezetimibe and those who were treated with high-intensity statin monotherapy (10.6% vs 12.3%; HR 0.87).
• Rates of that primary outcome in this older population were similar to those younger than 75 years (8.8% vs 9.4%; HR 0.94).
• Moderate-intensity statins and ezetimibe were linked with lower rates of intolerance-related drug discontinuation or dose reduction compared with high-intensity statin monotherapy among patients in the elderly group (2.3% vs 7.2%) and in those younger than 75 (5.2% vs 8.4%).
• Median LDL cholesterol levels remained consistently lower for elderly patients in the ezetimibe combination group compared with those receiving high-dose statin monotherapy at year 1 (59 vs 63 mg/dL), year 2 (58 vs 62 mg/dL), and year 3 (57 vs 64 mg/dL).
• The rate of new-onset diabetes was lower for the former compared with the latter treatment group (10.0% vs 18.7%), and there was a significant interaction noted compared with the under-75 group for this endpoint.

To conclude, combination therapy of moderate-intensity statin with ezetimibe showed similar CV benefits to high-intensity statin monotherapy with dose reduction in elderly patients with ASCVD having a higher risk of nonadherence, intolerance, and discontinuation with high-intensity statin therapy.