Older Patients May Benefit From Higher Intensity Lipid Therapy After ACS

Treatment with simvastatin-ezetimibe appears to be beneficial for elderly patients with acute coronary syndrome.

According to the results of a secondary analysis of the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), treatment with simvastatin-ezetimibe appears to be beneficial for patients ≥75 years old with stabilized acute coronary syndrome (ACS), compared with simvastatin alone.  

IMPROVE-IT was a randomized, double-blind, multicenter study that evaluated the outcomes and risks associated with high intensity lipid-lowering therapy in patients ≥50 years old after an ACS. Given that evidence supporting the use of intensive lipid lowering treatment in elderly patients is limited, the study authors used data obtained from IMPROVE-IT to compare higher intensity to lower intensity lipid-lowering therapy in patients ≥75 years old. 

Patients received either simvastatin (40mg)-ezetimibe (10mg) or simvastatin (40mg)-placebo daily and were followed over a median time period of 6 years. The primary composite end point of the study included “death due to cardiovascular disease, myocardial infarction, stroke, unstable angina requiring hospitalization, and coronary revascularization after 30 days.” Safety outcomes and lipid variables were also assessed.

Of the total patients enrolled in IMPROVE-IT (N=18,144), 2798 (15.4%) were ≥75 years old and 5173 (28.5%) were 65 to 74 years old. It was noted that three-quarters of the total patient population included in the study were male. 

“Treatment with simvastatin-ezetimibe resulted in lower rates of the primary end point than simvastatin-placebo, including 0.9% for patients younger than 65 years (hazard ratio [HR] 0.97; 95% CI, 0.90-1.05) and 0.8% for patients 65 to 74 years of age (HR 0.96; 95% CI, 0.87-1.06), with the greatest absolute risk reduction of 8.7% for patients 75 years or older (HR 0.80; 95% CI, 0.70-0.90) (P =.02 for interaction),” the study authors reported. Additionally, no difference in the rates of adverse events between the treatment groups was observed for any age. 

In an editorial discussing the results of this post hoc analysis, Antonio Gotto, MD, highlighted how valuable these results are for both the patient and provider. “They strongly support the benefit of intensive therapy to reduce LDL-C levels in elderly individuals with atherosclerotic cardiovascular disease,” Dr Gotto stated. He added that “The ongoing Statin Therapy for Reducing Events in the Elderly trial (NCT02099123) will provide additional information regarding the use of statin therapy in healthy individuals older than 70 years.”

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This article originally appeared on MPR