Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70–100 years: a contemporary primary prevention cohort
Review of the Copenhagen General Population Study (n=91,131) found those aged 70–100 years with elevated LDL cholesterol had the highest risk of cardiovascular disease and the lowest estimated NNT in 5 years to prevent one event from use of a moderate-intensity statin.
Source:
The Lancet
SPS commentary:
A separate meta-analysis found LDL cholesterol lowering reduced the risk of major vascular events in those at least 75 years old by 26% per 1mmol/L reduction (RR 0.74, 95%CI 0.61-0.89).
A related commentary discusses this research, and recommends that although it is clear lipid lowering therapy is beneficial in older patients, physician judgment and shared decision making are needed to determine whether the benefit of lipid-lowering treatment in older patients for both primary and secondary prevention of cardiovascular disease will outweigh risk, taking into account functional status, independence, and quality of life. important for deciding on the need
It adds that although lipid-lowering therapy was efficacious in older patients, the benefit of treating individuals when they are younger should not be forgotten. The average age of patients in all the trials analysed was older than 60 years, an age when atherosclerotic cardiovascular disease is already well established. It suggests that lipid-lowering therapy should be initiated at a younger age, preferably before age 40 years, in those at risk to delay the onset of atherosclerosis rather than try to manage the condition once fully established or advanced. Somewhat modest reductions in LDL cholesterol from a younger age might result in much larger benefits over time. The older one is when one starts lipid-lowering therapy, the less likely one is to benefit during one’s lifetime because of the greater cumulative exposure to LDL cholesterol before initiation of therapy. Additionally, more intensive lipid-lowering therapy is required to achieve significant short-term cardiovascular benefit. It concludes that when to start lipid-lowering therapy and the duration of therapy are probably more important than whether to start lipid-lowering therapy, particularly for the primary prevention of cardiovascular disease in older patients, for whom further evidence is required.