A large observational study suggests the answer is yes, providing needed data for patients 80 years and older.

Older age confers added risk for mortality after acute myocardial infarction (AMI); however, randomised, controlled trials of lipid-lowering therapy after AMI have typically excluded patients in the oldest age category of 80 years and older. Using data from a nationwide registry of adults discharged after AMI in France, researchers analysed the association between prescription of high-intensity lipid-lowering therapy (atorvastatin 40mg or more or equivalent, or any combination of statin plus ezetimibe) and five-year mortality in patients aged 80 years and older.

Among 2258 patients included in the study (mean age, 85±4 years; 51% women), five-year survival rates were as follows, based on the status and intensity of lipid-lowering therapy at discharge:

• no lipid-lowering therapy (n=415): 36%
• conventional intensity (n=866): 48%
• high intensity (n=977): 58%.

Compared with patients discharged on no lipid-lowering therapy, high-intensity therapy was associated with a 22% lower five-year mortality rate (adjusted hazard ratio [aHR], 0.78), but conventional-intensity lipid-lowering therapy was not associated with a significant mortality reduction (aHR, 0.93).

Comment: These are welcome data given prior exclusions of this age group from randomised trials of lipid-lowering therapy after AMI. As with any observational study, there are potential confounders. Patients receiving high-intensity therapy were younger, had fewer comorbidities and were more likely to present with ST-segment myocardial infarction. Although the analyses adjusted for these variables, residual confounding is still possible. In addition, this study could not capture adverse side effects of therapy. Nonetheless, these data give us confidence to treat older patients with high-intensity lipid-lowering therapy after AMI, just as we treat our younger patients.

Karol E. Watson, MD, PhD, FACC, John C. Mazziotta, MD, PhD, Term Endowed Chair and Professor of Medicine/Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, USA.

Fayol A, et al. Association of use and dose of lipid-lowering therapy post acute myocardial infarction with 5-year survival in older adults. Circ Cardiovasc Qual Outcomes 2024 Apr 29; e-pub (https://doi.org/10.1161/CIRCOUTCOMES.123.010685).

This summary is taken from the following Journal Watch titles: Cardiology, Hospital Medicine.