1. Effectiveness of low-density lipoprotein cholesterol reduction with lipid lowering therapy for secondary prevention amongst older individuals: a nationwide cohort study.
- Author
-
Andersson, Niklas W, Corn, Giulia, Dohlmann, Tine L, Melbye, Mads, Wohlfahrt, Jan, and Lund, Marie
- Subjects
TREATMENT of acute coronary syndrome ,STROKE treatment ,TRANSIENT ischemic attack treatment ,DRUG efficacy ,STATISTICS ,ANTILIPEMIC agents ,CONFIDENCE intervals ,AGE distribution ,REVASCULARIZATION (Surgery) ,LOW density lipoproteins ,DISEASE relapse ,PRE-tests & post-tests ,COMPARATIVE studies ,RESEARCH funding ,DESCRIPTIVE statistics ,DRUGS ,VASCULAR diseases ,DATA analysis ,PATIENT compliance ,PROPORTIONAL hazards models ,LONGITUDINAL method ,DISEASE risk factors ,EVALUATION ,MIDDLE age ,OLD age - Abstract
Background Data about the clinical benefit from initial low-density lipoprotein cholesterol (LDL-C) reduction with lipid lowering treatment for secondary prevention and risk of major vascular events amongst older as compared with younger individuals treated during routine clinical care are limited. We investigated this in a nationwide cohort. Methods Individuals aged ≥ 50 years with a first-time hospitalisation for a cardiovascular event (index event, including acute coronary syndrome, non-haemorrhagic stroke, transient ischaemic attack and coronary revascularisation), 1 January 2008 to 31 October 2018, who subsequently used lipid lowering treatment, and had an LDL-C measurement before and after the event were included. Hazard ratios (HRs) for major vascular events per 1 mmol/L reduction in LDL-C were estimated for the included 21,751 older and 22,681 younger individuals (≥/<70 years old) using Cox regression. Results LDL-C lowering was associated with a 12% lower risk of major vascular events in older individuals per 1 mmol/L reduction in LDL-C (HR 0.88, 95% confidence interval [CI] 0.84–0.93), with no significant difference compared with the risk reduction amongst younger individuals (HR 0.88, 95% CI 0.83–0.93; P -value for difference between age groups: 0.86). The risk reduction was more pronounced when post hoc restricting, as a proxy for compliance, to new users with an LDL-C reduction above the lowest decile for both older (0.81, 95% CI 0.73–0.90) and younger (0.81, 95% CI 0.72–0.91) individuals. Conclusions This study strongly supports a similar relative clinical benefit of LDL-C reduction with lipid lowering treatment for secondary prevention of major vascular events amongst individuals aged ≥70 and <70 years. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF