Reducing LDL cholesterol is just as beneficial for people over 70, research suggests.
People over 70 gain the same primary prevention benefits from cholesterol-lowering treatments as younger people, according to new research.
A Danish study of 65,000 people over 50 who were taking lipid-lowering therapy and had no history of atherosclerotic cardiovascular disease has found that older participants gained similar benefits to the younger cohort.
When the researchers compared data for the participants under 70 with those aged 70 and over, they found that the median LDL cholesterol reduction was 1.7mmol/L for both the older and the younger participants who were taking statins.
For every 1mmol/L reduction in LDL cholesterol in the older participants there was a 23% relative risk reduction of major vascular events, compared with a 24% reduction in the younger group.
The results were consistent across demographics, baseline LDL cholesterol levels, frailty and treatment factors, the researchers said.
They also found that the rate of hospitalisation due to a major vascular event such as acute coronary syndrome, non-haemorrhagic stroke or coronary revascularisation was similar among the two groups.
“Based on a general population sample and data derived from routine contemporary clinical practice, these results support the clinical benefit of lowering LDL cholesterol for primary prevention in older individuals and may contribute to informing guideline recommendations, clinician-patient discussion, and health care policies,” they wrote in the Journal of the American College of Cardiology.
Cardiologist and National Heart Foundation chief medical advisor Professor Garry Jennings AO said the new evidence was consistent with findings from smaller studies.
“This is pretty reassuring evidence that they’re effective and helpful in older people who have the right indications,” he said.
Professor Jennings said earlier trials with cholesterol-lowering drugs had included few people over the age of 70 due to more comorbidities and difficulties recruiting older people.
Professor Jennings told TMR that, based on this latest study, if a patient had very high cholesterol levels and was over 70, “it would be very reasonable for them to receive a statin” for primary prevention.
“There’s no prima facie reason why they would be any less effective or more problematic in older people than younger people. They’re well tolerated and quite widely used. So I think this is more reassurance than striking new data.”
Professor Jennings cautioned that drug side effects needed to be considered in older people, who were also more likely to be frail.
“I’m not aware of anything with statins that would suggest that older people are experiencing more problems, but it’s something you always consider.
“You don’t want to over-medicate older people and you don’t want polypharmacy if it can be avoided in older people, so you want to know that everything that they’ve been given has a potential benefit.”
The Danish researchers said previous data showing the benefits of LDL cholesterol–lowering treatment for cardiovascular risk reduction in older people was limited because that cohort were underrepresented in trials.
“This lack of evidence is particularly pronounced for primary prevention,” they said.
In an accompanying editorial, a US researcher said previous trials had often over-looked or underrepresented older people, or had enrolled relatively healthier seniors with fewer event rates.
“This contrasts with real-world settings where the patient population is diverse, with varying demographics and complex comorbidity profiles,” he said.
A review of 60 lipid-lowering therapy trials showed that fewer than half of participants were older than 65 years of age, almost half the trials imposed age limitations, often 75 years, and only 39% of trials reported data on older populations, he said.
“This underrepresentation casts doubt on the applicability of the results to older individuals. Consequently, cardiovascular society guidelines offer more cautious and weaker recommendations for older patients, emphasizing careful consideration of comorbidities before initiating LDL-C–lowering therapy in this age group.”
Journal of the American College of Cardiology 2023, online 25 September
