Intensive lipid-lowering strategies and major cardiovascular events in patients aged ≥65 years: A meta-analysis of...

Elderly patients have been underrepresented in trials that evaluated the effect of intensive lipid-lowering therapy (ILLT) on major adverse cardiovascular events (MACE).

We performed an intention-to-treat metanalysis of published data of phase III trials evaluating ILLT efficacy on MACE, mortality, myocardial infarction and stroke.

We analyzed 38,089 patients with age ≥65 from 11 trials. ILLT was associated to lower risk of MACE (HR: 0.85 95% CI 0.80-0.88; p < 0.001) and the effect was similar in all the age groups (heterogeneityI² = 37.7%, p = 0.098). The risk reduction of ILLT was significantly higher (p < 0.01) in primary prevention (HR: 0.66 95% CI 0.57-0.77; p < 0.001) as compared to secondary prevention (HR: 0.86 95% CI 0.82-0.91 p < 0.001). Mortality risk reduction was reported in 7 trials but only a non-significant tendency to lower cardiovascular mortality (HR: 0.94 95% CI 0.84-1.05; p = 0.28) and all-cause mortality (HR: 0.94 95% CI0.87-1.02; p = 0.15) was observed; in contrast, ILLT reduced the risk of myocardial infarction (HR: 0.84 95% CI 0.77-0.90; p = 0.001) and stroke (HR: 0.71 95% CI 0.58-0.86; p < 0.001).

ILLT reduces the risk of MACE in the elderly. The risk reduction was similar in all age groups and could be even higher in primary prevention.