Study finds similar primary prevention benefits of lowering LDL cholesterol in younger and older statin users

The Danish nationwide cohort study found similar primary prevention benefits of lowering LDL cholesterol between statin users under and over the age of 70 years. The researchers revealed that each 1 mmol/L reduction in LDL cholesterol achieved was tied to a reduced risk of major vascular events in older (HR 0.77) and younger individuals alike (HR 0.76) following 2.5 years of follow-up, starting 1 year after the start of lipid-lowering therapy with statins alone or with other agents.

They reported that events prevented irrespective of the age cutoff were a composite of non-hemorrhagic stroke, acute coronary syndrome, and coronary revascularization -- all similarly reduced in a separate analysis using a cutoff of 75 years. 

LDL (low-density lipoprotein) cholesterol with lipid-lowering therapy has consistently been shown to reduce the risk of cardiovascular disease (CVD) in primary prevention trials where the majority of individuals are aged <70 years. There is less clarity of evidence for older individuals.

In the study, Niklas Worm Andersson, Statens Serum Institut, Copenhagen, Denmark, and colleagues sought to compare the clinical effectiveness of lowering LDL cholesterol using lipid-lowering therapy for primary prevention of CVD among older and younger individuals in a Danish nationwide cohort.

They included individuals aged ≥50 years who had initiated lipid-lowering therapy from 2008 to 2017, had no history of atherosclerotic CVD, and had a baseline and a within-1-year LDL cholesterol measurement. They evaluated the associated risk of major vascular events among older individuals (≥70 years) by HRs per 1 mmol/L reduction in LDL cholesterol versus younger individuals (<70 years).

The study revealed the following findings:

• For both the 16,035 older and the 49,155 younger individuals, the median LDL cholesterol reduction was 1.7 mmol/L.
• Each 1 mmol/L reduction in LDL cholesterol in older individuals was significantly associated with a 23% lower risk of major vascular events (HR: 0.77), which was equal to that of younger individuals (HR: 0.76). Similar results were observed across all secondary analyses.

"Our study supports a relative clinical benefit of LDL cholesterol lowering for primary prevention of major vascular events in people aged ≥70 years similarly as in individuals aged <70 years," the researchers wrote. "Lipid-lowering conferred no reduction in mortality for either the young or the old."

Reference:

Andersson NW, et al "LDL-C reduction with lipid-lowering therapy for primary prevention of major vascular events among older individuals" J Am Coll Cardiol 2023; DOI: 10.1016/j.jacc.2023.07.027.