Lipid lowering in patients older than 75 yields clinical benefit

Main conclusion

LDL cholesterol (LDL-c) lowering significantly reduced the risk of major vascular events (n=3 519) in older patients, by 26% per 1 mmol/L reduction in LDL-c (RR : 0.74; 95%CI : 0.61–0.89; p=0.0019), with no statistically significant difference with the risk reduction in patients younger than 75 years (0·85; 0·78–0·92 ; interaction p=0·37) and no significant difference between statin (0·82 ; 0·73–0·91) and non-statin treatment (0·67 ; 0·47–0·95).

Type of study

Systematic review and meta-analysis of randomised controlled trials ended after March 1, 2015 that evaluated a LDL-c-lowering drug, with a median follow-up of at least 2 years and data on older ≥75 years patients: 29 trials, 244 090 patients, 21 492 (8·8%) aged at least 75 years; 11 750 (54·7%) from statin trials, 6 209 (28·9%) from ezetimibe trials, and 3533 (16·4%) from PCSK9 inhibitor trials.

Main message for clinical practice

As in patients older than 75 years, LDL-c-lowering therapy seems as effective in reducing cardiovascular events as it is in younger, this should strengthen guideline recommendations for the use of LDL-c-lowering drugs, including non-statin treatment, in this population, without not lose sight of the benefit of treating individuals when they are younger.