October 2023
How does age affect LDL-cholesterol response to statin therapy?

Older adults who received low- and moderate-intensity statins had slightly greater LDL-cholesterol reduction than did younger adults.

Data suggest that statins potentially could benefit many older adults, who have been underrepresented in clinical trials (NEJM JW Gen Med Jan 15 2021 and Lancet 2020; 396: 1637­-1643). To clarify the relation between age and LDL­-cholesterol response to statins, researchers in Denmark used nationwide databases to study 84,000 adults (about 10,000 were older than 75 years) who started taking simvastatin or atorvastatin between 2008 and 2018.

In patients who initiated low­ or moderate­-intensity statins, the magnitude of LDL­-cholesterol reduction was greater among those 75 years or older than among those 50 years or younger. The difference in LDL­-cholesterol reduction between the two age groups was 2.6 percentage points, equivalent to an absolute mean difference of about 0.10 mmol/L. Age­based differen­ces in statin response were similar among primary­- and secondary­-prevention subgroups, but these differences were attenuated in patients who used high­ intensity statins and those with normal renal function.

Comment: Statins might be slightly more effective at lowering LDL-cholesterol in older adults than in younger people. We do not know whether these small LDL­-cholesterol differences are clinically meaningful, but the results could support initiating statins at lower doses in some older patients. Such groups might be older patients who take statins for primary prevention (where the absolute risks for cardiovascular events generally are lower than for patients taking statins for secon­ dary prevention) and patients taking numerous medications (in whom unanti­cipated drug interactions are more common).

Molly S. Brett, MD, Assistant Professor of Medicine, University of Colorado, Boulder, USA.

Corn G, et al. Association between age and low-density lipoprotein cholesterol response to statins: a Danish nationwide cohort study. Ann Intern Med 2023; 176: 1017-1026.

This summary is taken from the following Journal Watch titles: General Medicine, Cardiology, Ambulatory Medicine.

Ann Intern Med