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Benefits of achieving the NCEP optional LDL-C goal among elderly patients with ACS

Kausik K Ray1, Richard G Bach, Christopher P Cannon

  • 1The TIMI Study Group and Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital/Harvard Medical School, Boston, MA 02115, USA. koshray@gmail.com

European Heart Journal
|August 5, 2006
PubMed

Insights

Achieving the NCEP low-density lipoprotein cholesterol (LDL-C) goal (<1.8 mmol/L) after acute coronary syndrome (ACS) is safe and effective for elderly patients, offering significant risk reduction comparable to younger individuals.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Clinical Lipidology

Background:

  • Secondary prevention after acute coronary syndrome (ACS) is crucial for reducing recurrent events.
  • The National Cholesterol Education Program (NCEP) established LDL-C goals to guide lipid-lowering therapy.
  • The efficacy and safety of intensive LDL-C lowering in elderly ACS patients require specific evaluation.

Purpose of the Study:

  • To evaluate the effectiveness and safety of achieving the NCEP LDL-C goal (<1.8 mmol/L) in elderly patients (≥70 years) following ACS.
  • To compare the outcomes of elderly patients with their younger counterparts in achieving this lipid goal.

Main Methods:

  • Analysis of data from the PROVE IT-TIMI 22 trial.
  • Comparison of clinical outcomes (death, myocardial infarction, unstable angina) based on LDL-C levels at 30 days post-ACS.
  • Stratification of patients into elderly (≥70 years) and younger groups.

Main Results:

  • In 634 elderly patients, achieving the NCEP LDL-C goal was linked to an 8% absolute and 40% relative risk reduction of adverse events (HR 0.60, P=0.008).
  • Younger patients (n=3150) showed a 2.3% absolute and 26% relative risk reduction (HR 0.74, P=0.013).
  • An estimated 80 events per 1000 patients could be prevented in the elderly, compared to 23 in younger patients, over 2 years. Major side effects were similar across age groups and statin regimens.

Conclusions:

  • Achieving the NCEP LDL-C goal is as safe and effective in elderly ACS patients as in younger patients.
  • Intensive LDL-C lowering is a viable secondary prevention strategy for older adults post-ACS.
  • The findings support the application of NCEP lipid goals in geriatric populations with ACS.
Abstract

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