Lowering low-density lipoprotein, or LDL, cholesterol has similar benefits for older adults and younger people, a study published in the October edition of the Journal of the American College of Cardiology found.
There hasn’t been a lot of research on the effects of lowering LDL — also known as bad cholesterol — in older people. Giving older adults LDL-lowering therapy is often a secondary prevention in that population. There are concerns about cognitive impairment and muscle damage in this population and limited evidence, the authors reported.
For the study, researchers broke people into two groups. One group had 49,155 people ages 50 through 69; the other had 16,035 people over 70 (the mean age was 75.5 years old). The subjects didn’t have a history of atherosclerotic cardiovascular disease, but had high cholesterol.
In both groups, nearly 80% began moderate lipid-lowering treatment. Then the researchers began following up for two-and-a-half years, starting a year after people began treatments.
The participants in the study had a median reduction of cholesterol of 1.7 mmol/L. Every 1 mmol/L reduction in LDL cholesterol among older people was linked to a 23% lower risk for major vascular events — about equal to the younger people.
“Of note, any potential clinical benefit should be balanced against the potential of harm, and this study did not assess the safety of lipid-lowering treatment according to age,” the report authors wrote.
“Evidence from clinical trials of treatments lowering LDL cholesterol has shown that the relative risk of major vascular events is reduced by about one-fifth per each 1 mmol/L lowering of LDL cholesterol. For older individuals, however, data to support the benefit of LDL cholesterol-lowering treatment for cardiovascular risk reduction are sparse because elderly people are generally underrepresented in the individual trials,” said Niklas Andersson, MD, of Statens Serum Institut in Copenhagen, Denmark.
The US Preventive Services Task Force states that there’s not enough evidence to recommend starting statins in people past the age of 76 who don’t have a history of cardiovascular disease. The research showed benefits, and adds to the evidence that may support statin use in some older people.
“Balancing risk and benefit is particularly crucial in primary prevention, and more so in the older population, where conditions such as statin-induced myalgias can have a disproportionate impact,” commented Safi Khan, MD, a fellow at Houston Methodist DeBakey Heart and Vascular Center, in an accompanying editorial.
“Ultimately, physicians must have comprehensive discussions with patients about the potential harms and benefits of LDL-[cholesterol] reduction therapy to guide informed personalized treatment choices,” he wrote.
