(HealthDay News) — Older adults have an increased risk for myocardial infarction and atherosclerotic cardiovascular disease (ASCVD) in association with elevated levels of low-density lipoprotein (LDL) cholesterol; and LDL-lowering therapies are effective for reducing cardiovascular events in older adults, according to two studies published online in The Lancet.

Martin Bødtker Mortensen, PhD, from Aarhus University Hospital, and Børge Grønne Nordestgaard, MD, from Copenhagen University — both in Denmark — examined the association between elevated LDL cholesterol and myocardial infarction and ASCVD in individuals aged 20 to 100 years. The researchers found that for the overall population, the risk for myocardial infarction was augmented per 1.0-mmol/L increase in LDL cholesterol (hazard ratio, 1.34) and was amplified for all age groups, especially those aged 70 to 100 years. Per 1.0-mmol/L increase in LDL cholesterol, the risk for atherosclerotic cardiovascular disease was increased overall (hazard ratio, 1.16) and in all age groups, especially for those aged 70 to 100 years.

Baris Gencer, MD, from Harvard Medical School in Boston, and colleagues conducted a systematic review relating to LDL cholesterol-lowering therapies in older patients. Data were included from 6 articles, which included 29 trials with 244,090 patients (8.8% aged at least 75 years). The researchers found that in older patients, LDL cholesterol lowering significantly reduced the risk for major vascular events per 1-mmol/L reduction in LDL cholesterol (risk ratio, 0.74). The benefit for older adults was observed for each component of the composite: cardiovascular death, myocardial infarction, stroke, and coronary revascularization.

“Although lipid-lowering therapy was efficacious in older patients, we should not lose sight of the benefit of treating individuals when they are younger,” write the authors of an accompanying editorial.


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Several authors from the Gencer study disclosed financial ties to the pharmaceutical industry.

References

Mortensen M, Nordestgaard BG.  Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70–100 years: a contemporary primary prevention cohort. Lancet. Published online November 10, 2020.

Gencer B, Marston NA, Im K, et al. Full TextEfficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials. Lancet. 

Raal FJ, Mohamedorial F. Never too old to benefit from lipid-lowering treatment. Lancet.