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

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.