A contemporary primary prevention cohort study and a systematic review and meta-analysis showed that older people with elevated LDL cholesterol had higher absolute risk of atherosclerotic cardiovascular disease (CVD), and lipid lowering was as effective in reducing cardiovascular events as it was in younger ones. The cohort study included 13 779 individuals aged 70–100 years and 77 352 aged 20–69 years in the Danish general population from Nov 25, 2003 to Feb 17, 2015. During mean 7·7 years of follow-up, 1515 individuals had the first myocardial infarction (MI) and 3389 had atherosclerotic CVD. MI and atherosclerotic CVD increased with both higher LDL cholesterol levels and older age. The older people with higher absolute risk benefited the most from lipid lowering for primary prevention compared to younger people with higher relative risk. The meta-analysis included 244 090 patients from 29 trials (predominantly secondary prevention studies), 21 492 (8·8%) were aged at least 75 years, of whom 11 750 (54·7%) were from statin trials, 6209 (28·9%) from ezetimibe trials, and 3533 (16·4%) from PCSK9 inhibitor trials. Median follow-up ranged from 2·2 to 6·0 years. LDL cholesterol lowering significantly reduced the risk of major vascular events (n=3519) in older patients by 26% per 1 mmol/L reduction in LDL cholesterol (risk ratio 0·74), with no statistically significant difference in the risk reduction in patients younger than 75 years (0·85). Among older patients, risk ratios were not statistically different for statin (0·82) and non-statin treatment (0·67). The benefit of LDL cholesterol lowering in older patients was observed for each component of the composite, including cardiovascular death (0.85), MI (0·80), stroke (0·73), and coronary revascularization (0·80). The findings support the cumulative burden of LDL cholesterol over a person’s lifetime, and that available randomized controlled trial evidence has not indicated an upper age threshold beyond which statin therapy does not reduce risk but differ from reports from cohorts enrolled decades ago probably due to favorable changes in life expectancy. Source: https://www.thelancet.com/
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