Key result
Statins provide similar LDL reduction in very elderly versus elderly patients but cause more adverse reactions.
Why the study?
The efficacy and safety of moderate- to high-intensity statin therapy in elderly and very elderly patients have not been clearly proven.
Does high-intensity statin therapy improve LDL reduction and ASCVD risk without increasing adverse drug reactions in very elderly patients compared to elderly patients?
Observational (n=610)
Does high-intensity statin therapy improve LDL reduction and ASCVD risk without increasing adverse drug reactions in very elderly patients compared to elderly patients?
In very elderly patients (≥75 years), high-intensity statins do not provide greater ASCVD risk reduction than lower intensities but are associated with more adverse drug reactions, suggesting a stepwise approach is preferable.
May warrant caution with statin use in very elderly patients; leaves open confirmation of risk-benefit balance in randomized trials.
Purpose: Although moderate- to high-intensity statin therapy is increasingly recommended in cardiovascular disease patients, the efficacy and safety in elderly patients have not been proven clearly. Here, we compare the effect of various-intensity statins between elderly and very elderly patients. Methods: 43,870 patients over 65 years old who were treated with statins were screened using electronic medical record data. Results: We evaluated 451 patients in the elderly group aged 65–74 years and 159 patients in the very elderly group over 75 years old. Baseline cholesterol profiles were similar between the 2 groups, but the 10-year atherosclerotic cardiovascular disease (ASCVD) risk was significantly higher in the very elderly (20.9 ± 11.5% vs. 37.2 ± 13.6%, p < 0.001). The reduction rate of low-density lipoprotein (LDL) (–40.2 ± 21.3% vs. –39.3 ± 21.0%, p = 0.634) and the ratio of target LDL attainment (74.2 vs. 79.2%, p = 0.252) were similar between the 2 groups. Low-intensity statins showed comparable LDL cholesterol reduction with moderate-intensity statins both in the elderly and the very elderly groups. The 10-year ASCVD risk reduction was similar between the 2 groups (–3.5 ± 4.9% vs. –3.0 ± 8.4%, p = 0.480), but in the very elderly group, no different ASCVD reduction rate was shown in low- to high-intensity statins (p = 0.784). Only the elderly group showed a significant correlation (r = 0.112, p = 0.017) with LDL reduction and 10-year ASCVD risk. Interestingly, the incidence of adverse drug reaction (ADR) was higher in the very elderly group (4.4%) than in the elderly group (2.7%) and was more frequent in high-intensity statin therapy. Conclusion: The efficacy of statins in LDL reduction was similar between the elderly and very elderly population. However, the benefit of moderate- to high-intensity statins is limited considering potential ADR. Therefore, the stepwise intensification of statin therapy might be necessary for the very elderly in spite of the higher cardiovascular risk.
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Lee et al. (2018) conducted an observational in Cardiovascular disease (n=610). Statin therapy vs. Elderly patients (65-74 years) was evaluated on Reduction rate of low-density lipoprotein (LDL) (p=0.634). Statin therapy yielded similar LDL reduction in very elderly and elderly patients (-39.3% vs -40.2%, p=0.634), but adverse drug reactions were more frequent in the very elderly (4.4% vs 2.7%).
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