Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials

Should we treat high LDL cholesterol in ‘healthy’ elderly individuals?

“…Whether these individuals derive net benefit from LDL-C lowering therapy, however, is still unclear. The current CTTC analysis did not show a significant reduction in risk of vascular events per 1.0 mmol/L lowering of LDL-C in elderly primary prevention cohorts [13]. Non-vascular effects from initiating LDL-C lowering therapy in elderly patients without ASCVD also need to be considered, given that the CTTC meta-analysis showed a lack of benefit from LDL-C lowering therapy on non-vascular mortality [13].…”

“…There was also no evidence to indicate safety concerns with statin or non-statin therapy in the elderly, with no increase in the risk of cancer, or the risk of haemorrhagic stroke, new-onset diabetes or neurocognitive effects with non-statin therapy, compared with younger individuals. [13] Other studies, such as the Patient and Provider Assessment of Lipid Management (PALM) registry, also report that LDL-C lowering treatment was similarly well tolerated in older and younger adults [14].…”

“…This uncertainty was addressed in the latest meta-analysis from the CTTC [13]. This was the largest to date, involving 21,492 individuals aged ≥75 years, predominantly with manifest ASCVD, in 29 trials of statin (54.7%, n = 11,750), ezetimibe (28.9%, n = 6209), or PCSK9 inhibitor therapy (16.4%, n = 3533) [13].…”

“…This uncertainty was addressed in the latest meta-analysis from the CTTC [13]. This was the largest to date, involving 21,492 individuals aged ≥75 years, predominantly with manifest ASCVD, in 29 trials of statin (54.7%, n = 11,750), ezetimibe (28.9%, n = 6209), or PCSK9 inhibitor therapy (16.4%, n = 3533) [13]. Over a median follow-up of 2.2-6.0 years, treatment with an LDL-C lowering agent reduced the risk of major vascular events by 26% per 1.0 mmol/L decrease in LDL-C, with no significant difference compared with that observed in younger individuals.…”

“…Importantly, the magnitude of clinical benefit per 1.0 mmol/L decrement in LDL-C levels did not differ significantly between statin and non-statin therapy. Incidentally, supplementary analyses showed no benefit from LDL-C lowering in elderly individuals without manifest vascular disease [13].…”