Abstract Background Lipid-lowering therapies (LLT), primarily statins, have demonstrated significant efficacy in reducing fatal and nonfatal cardiovascular events across diverse patient populations after acute myocardial infarction (MI).Current evidence regarding the optimal intensity of LLT for post-MI patients aged over 80 years remains insufficient. Purpose To assess the association between different intensity of LLT and long-term mortality LLT in patients over 80 years old following AMI. Methods This cohort study included patients hospitalized with AMI aged over 80 years, using data from province-wide electronic health records in China between 2013 and 2022. The exposure was intensity LLT (low-intensity versus moderate and high intensity). Low intensity LLT was defined as 5mg rosuvastatin, 10mg and 15mg atorvastatin, or any other statins every day. Moderate and high intensity LLT was defined as 10 mg or more atorvastatin, 20 mg or more rosuvastatin, PCSK9 inhibitor, or any combination of ezetimibe, PCSK9 inhibitor and statins. Patients who died within 30 days of admission were excluded. The primary outcome was 3-year all-cause mortality, with secondary outcomes including cardiovascular mortality, recurrent MI and stroke. Multivariable adjusted Cox model was used to calculated hazard ratio (HR) and 95% confidence interval (CI). Results Among the 11,585 patients, 3,559 received low-intensity LLT, and 8,026 received moderate and high intensity LLT, with survival rate of 29.1% and 21.4% respectively at 3-year. Compared with low-intensity LLT group, moderate and high intensity LLT was associated with a statistically significant reduction in 3-year all-cause mortality (HR, 0.81 95% CI: 0.75-0.88; P 0.001 and cardiovascular mortality (HR, 0.79 95% CI: 0.71-0.88; P 0.001). No significant differences were observed for recurrent MI (HR, 0.94 95% CI: 0.84-1.05; P = 0.297) or stroke (HR, 0.94 95% CI: 0.83-1.06; P = 0.311). In subgroup analyses, female appeared to benefit more from higher intensity LLT (HR, 0.75 95% CI: 0.67-0.85) than male (HR, 0.88 95% CI: 0.79-0.99), with a statistically significant interaction (Pint = 0.040). Sensitivity analyses revealed consistent results. Conclusion Moderate and high intensity LLT were associated with a significant reduction in all-cause and cardiovascular mortality at 3 years among MI patients aged over 80 years, compared to low intensity LLT. These results were predicated on the foundation of effective LLT in our analysis, which provided valuable guidance for clinicians when prescribing lipid-lowering therapies for elderly myocardial infarction patients.
Jiang et al. (Sat,) studied this question.