Daily Dose: Late Start for Statins Still a Win?

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On August 1, 2023 we reported on a study published in Annals of Internal Medicine that investigated the association between age and LDL-C reduction by statins.

The study

Researchers conducted a nationwide, register-based cohort study among persons in Denmark between 2008 and 2018. The cohort included 82 958 participants who received simvastatin or atorvastatin, who had LDL-C levels measured before and during statin use, according to the study abstract. Among the study cohort, 10 388 (13%) of participants were aged ≥75 years.

The main outcomes were statin response—defined for the purpose of the study as the percentage reduction in prestatin LDL-C level—and percentage reduction differences (PRDs) according to age and simvastatin or atorvastatin dose based on a longitudinal model for LDL-C.

The findings

Results showed that participants aged ≥75 years experienced greater reductions in LDL-C levels compared to those aged ≤50 years:

• 39% vs 33.8% for those who received simvastatin 20 mg

• 44.2% vs 40.2% for those who received atorvastatin 20 mg

Investigators noted the adjusted PRD for adults aged ≥75 years compared to those aged ≤50 years was 2.62 percentage points. This association, they added, was consistent for primary prevention (2.54 percentage points) and secondary prevention (2.32 percentage points) but smaller for those who initiated high-intensity statins (atorvastatin 40 mg: 1.36 percentage points; atorvastatin 80 mg: −0.58 percentage point).

Authors' commentary

"Low- to moderate-intensity statins were associated with a greater reduction in LDL-C levels in older persons than younger persons and may be more appealing as initial treatment in older adults who are at increased risk for adverse events."

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