(173) The Association Between Age and Low-Density Lipoprotein Cholesterol Response to Statins

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 847

Presenting Author(s)

Giulia Corn
– Statens Serum Institut, K�benhavn S, Hovedstaden, Denmark

Co-Author(s)

Mads Melbye
– K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
Mark A. Hlatky
– Department of Health Policy and Department of Medicine, Stanford University School of Medicine, Stanford, United States
Jan Wohlfahrt
– Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
Marie Lund
– Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark

Background: The reduction in low-density lipoprotein cholesterol (LDL-C) from statin treatment may vary according to the age of the individual treated. This is of particular interest for the elderly, who have been largely excluded from randomized controlled trials.

Objectives: To determine the association between the low-density lipoprotein cholesterol (LDL-C) response to statin treatment according to age.

Methods:

Design: Register-based nationwide cohort study (data from routine clinical practice).
Setting/participants: Adults (age ≥18 years) with a known Danish address who initiated first-time treatment with either simvastatin or atorvastatin between January 2008 and March 2018, and had available data on both pre-statin and on-statin LDL-C levels (n=89,006).
Exposure: Age at statin initiation, atorvastatin or simvastatin dose.
Main outcome: We defined statin response as percentage reduction in pre-statin LDL-C.
Statistical analysis: We estimated percentage reduction differences (PRD) using linear regression according to age and statin type and dose, adjusting for sex, calendar year, and pre-statin LDL-C level.

Results: Among 89,006 statin initiators, 11,199 (13%) individuals were ≥ 75 years. For low to moderate intensity statins, initiators ≥ 75 years had higher mean LDL-C percentage reductions than initiators < 50 years, e.g. 39.5% vs. 34.2% for simvastatin 20 mg, and 44.9% vs. 40.6% for atorvastatin 20 mg. The adjusted PRD for initiators ≥ 75 years compared with < 50 years ranged between 5.18 and 6.88 percentage points, similar to the PRD observed with a doubling of the statin dose (PRD 4.87 for simvastatin and 5.46 for atorvastatin). The observed association with age was not explained by indication for statin treatment, pre-statin LDL-C level, renal function, or prescription renewals.

Conclusions: The LDL-C percentage reduction after initiation of low to moderate intensity statins increases with age, and suggests low dose statins may be preferred as initial treatment in the elderly.