Benefit of Lipid lowering treatment extends to elderly as well: Lancet
USA: Amid the debate on clinical benefit of LDL cholesterol lowering treatment in older patients, a recent study has found the treatment to be equally effective (in reducing cardiovascular events) for both patients older than 75 years and patients younger than 75 years. The findings of the study, published in the journal Lancet, should help in strengthening guideline recommendations for lipid-lowering therapies (including non-statin treatment) use in older patients.
For the purpose, the researchers searched the online databases for RCTs of cardiovascular outcomes of an LDL cholesterol-lowering drug recommended by the 2018 American College of Cardiology and American Heart Association guidelines, with a median follow-up of at least 2 years and data on older patients (aged ≥75 years). The trials that exclusively enrolled participants with heart failure or dialysis were excluded as lipid-lowering therapy is not recommended in such patients. The researchers meta-analysed the risk ratio (RR) for major vascular events (a composite of cardiovascular death, myocardial infarction or other acute coronary syndrome, stroke, or coronary revascularisation) per 1 mmol/L reduction in LDL cholesterol.
The systematic review and meta-analysis included data from six articles which included 24 trials from the Cholesterol Treatment Trialists' Collaboration meta-analysis plus five individual trials.
Among 244 090 patients from 29 trials, 21 492 (8·8%) were aged at least 75 years, of whom 11 750 (54·7%) were from statin trials, 6209 (28·9%) from ezetimibe trials, and 3533 (16·4%) from PCSK9 inhibitor trials. Median follow-up ranged from 2·2 years to 6·0 years.
Key findings of the study include:
- LDL cholesterol lowering significantly reduced the risk of major vascular events (n=3519) in older patients by 26% per 1 mmol/L reduction in LDL cholesterol (RR 0·74), with no statistically significant difference with the risk reduction in patients younger than 75 years (0·85).
- Among older patients, RRs were not statistically different for statin (0·82) and non-statin treatment (0·67).
- The benefit of LDL cholesterol lowering in older patients was observed for each component of the composite, including cardiovascular death (0·85), myocardial infarction (0·80), stroke (0·73), and coronary revascularisation (0·80).
"These results should strengthen guideline recommendations for the use of lipid-lowering therapies, including non-statin treatment, in older patients," concluded the authors.
"Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials," is published in the journal Lancet.
DOI: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32332-1/fulltext
