Association of Use and Dose of Lipid-Lowering Therapy Post Acute Myocardial Infarction With 5-Year Survival in Older Adults.

Background: Older people are underrepresented in randomized trials. The association between lipid-lowering therapy (LLT) and its intensity after acute myocardial infarction and long-term mortality in this population deserves to be assessed.
Methods: The FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) program consists of nationwide French surveys including all patients admitted for acute myocardial infarction ≤48 hours from onset over a 1- to 2-month period in 2005, 2010, and 2015, with long-term follow-up. Numerous data were collected and a centralized 10-year follow-up was organized. The present analysis focused on the association between prescription of LLT (atorvastatin ≥40 mg or equivalent, or any combination of statin and ezetimibe) and 5-year mortality in patients aged ≥80 years discharged alive. Cox multivariable analysis and propensity score matching were used to adjust for baseline differences.
Results: Among the 2258 patients aged ≥80 years (mean age, 85±4 years; 51% women; 39% ST-segment elevation myocardial infarction; 58% with percutaneous coronary intervention), 415 were discharged without LLT (18%), 866 with conventional doses (38%), and 977 with high-dose LLT (43%). Five-year survival was 36%, 47.5%, and 58%, respectively. Compared with patients without LLT, high-dose LLT was significantly associated with lower 5-year mortality (adjusted hazard ratio, 0.78 [95% CI, 0.66-0.92]), whereas conventional-intensity LLT was not (adjusted hazard ratio, 0.93 [95% CI, 0.80-1.09]). In propensity score-matched cohorts (n=278 receiving high-intensity LLT and n=278 receiving no statins), 5-year survival was 52% with high-intensity LLT at discharge and 42% without statins (hazard ratio, 0.78 [95% CI, 0.62-0.98]).
Conclusions: In these observational cohorts, high-intensity LLT at discharge after acute myocardial infarction was associated with reduced all-cause mortality at 5 years in an older adult population. These results suggest that high-intensity LLT should not be denied to patients on the basis of old age.
Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00673036, NCT01237418, and NCT02566200.
Competing Interests: Disclosures Dr Schiele reports research grants/lecture fees from Amgen, Bayer, Bouchara-Recordati, Sanofi-Aventis, Servier, Novo Nordisk, Lilly, Organon, Bouchara-Recordati, Boehringer Ingelheim, Lilly, Novartis, and Amarin. Dr Ferrières reports speaking fees for Amgen, Sanofi, Servier, and Merck, Sharp & Dohme. Dr Puymirat has received research grants/lecture fees from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Bouchara-Recordati, Biotronik, Bristol-Myers Squibb, Boehringer Ingelheim, Bracco, Cordis, Daiichi-Sankyo, Lilly, Merck, Sharp & Dohme, Novartis, Novo Nordisk, Organon, Pfizer, Sanofi, Servier, Sunpharm, and Vifor Pharma. Dr Lemesle reports having received fees for consulting and travel support from Alnylam, Amarin, Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Merck, Sharp & Dohme, Novartis, Novo Nordisk, Organon, Pfizer, Recordati, Sanofi Aventis, and Servier. Dr Cayla has received research grants/lecture fees from Abbott, Amgen, AstraZeneca, Bristol Myers Squibb, Edwards, Microport Cardiac Rhythm Management, Medtronic, and Pfizer. Dr Simon reports having received grants or lecture fees or participation in scientific boards from Ablative Solutions,Air Liquide, AstraZeneca, Bayer, Boehringer, Daiichi-Sankyo, Eli-Lilly, Glaxo-Smith-Kline, Novartis, Servier, and 4Living Biotech Sanofi. Dr Danchin has received personal fees and nonfinancial support from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Sanofi, personal fees from Boehringer Ingelheim, Intercept, Merck, Sharp & Dohme, Novo Nordisk, Pfizer, Servier, Union Chimique Belge Pharmaceuticals, and Vifor, all outside the submitted work. The other authors report no conflicts.