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Lowering LDL cholesterol in older patients is beneficial

Presented by
Dr Baris Gencer, Brigham and Women’s Hospital, USA
AHA 2020


In patients aged ≥75 years, lipid-lowering therapy was as effective in reducing cardiovascular events as it was in patients <75 years. A 26% reduction was seen in major events per 1 mmol/L reduction of low-density lipoprotein (LDL) cholesterol. These results from a systematic review and meta-analysis should strengthen guideline recommendations for the use of lipid-lowering therapies in older patients [1].

Dr Baris Gencer (Brigham and Women’s Hospital, USA) presented a systematic review and meta-analysis, which included 24 trials from the Cholesterol Treatment Trialists’ Collaboration meta-analysis, as well as 5 randomised controlled cardiovascular outcome trials, all recently published (2015–2020). The results were simultaneously published in The Lancet [2].

In total, the analysis included 244,090 patients, 21,492 (8.8%) of whom were aged ≥75 years. Of those, 11,750 (54.7%) were from statin trials, 6,209 (28.9%) from ezetimibe trials, and 3,533 (16.4%) from PCSK9 inhibitor trials. Median follow-up was between 2.2 years and 6.0 years.

The results showed that lowering LDL cholesterol significantly reduced major vascular events (n=3,519) by 26% per 1-mmol/L LDL cholesterol reduction: RR 0.74; 95% CI 0.61–0.89 (P=0.002). This effect was not significantly less compared with patients younger than 75 years: RR 0.85; 95% CI 0.78–0.92 (Pinteraction=0.24). Among older patients, relative risks were not statistically different for statin (RR 0.81; 95% CI 0.70–0.94) and non-statin therapy (0.67; 95% CI 0.47–0.95; Pinteraction=0.60). The benefit of LDL cholesterol lowering in older patients was observed for each component of the composite, including:

      1. cardiovascular death (RR 0.85; 95% CI 0.74–0.98);
      2. myocardial infacrtion (RR 0.80; 95% CI 0.71–0.90);
      3. stroke (RR 0.73; 95% CI 0.61–0.87); and
      4. coronary revascularisation (RR 0.80; 95% CI 0.66–0.96).


    1. Gencer B, et al. Efficacy of Lowering Low-density Lipoprotein Cholesterol in Elderly Subjects: A Systematic Review and Meta-analysis of Randomized Controlled Trials. P389, AHA Scientific Sessions 2020, 13–17 Nov.
    2. Gencer B, et al. Lancet. 2020;396(10263):1637–1643.


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