A nationwide study from Denmark shows a greater LDL cholesterol response for adults aged 75 years or older to low- to moderate-intensity statins than in people younger than 50 years. The findings indicate that lower statin intensity “may be more appealing as initial treatment in older adults who are at increased risk for adverse events,” the authors conclude. “Our finding that age is a significant independent predictor of LDL-C response to statin treatment initiation extends those of previous studies in smaller, selected trial populations.”
The register-based cohort study included 82,958 simvastatin or atorvastatin initiators with LDL-C measurements before and during statin use from 2008 to 2018. Statin response was measured as the percentage reduction in prestatin LDL-C level and the percentage reduction differences (PRDs) according to age and simvastatin or atorvastatin dose based on a longitudinal model for LDL-C.
“Among 82,958 statin initiators, 10,388 (13%) were aged 75 years or older,” the authors write. “With low- to moderate-intensity statins, initiators aged 75 years or older had greater mean LDL-C percentage reductions than initiators younger than 50 years—for example, 39.0% versus 33.8% for simvastatin, 20 mg, and 44.2% versus 40.2% for atorvastatin, 20 mg. The adjusted PRD for initiators aged 75 years compared with initiators aged 50 years was 2.62 percentage points. This association was consistent for primary prevention (2.54 percentage points) and secondary prevention (2.32 percentage points) but smaller for initiators of high-intensity statins (atorvastatin, 40 mg: 1.36 percentage points; atorvastatin, 80 mg: −0.58 percentage point).”