High LDL Cholesterol Impacts MI, ASCVD Risks Among Older Adults

Individuals aged 70 to 100 years with elevated low-density lipoprotein (LDL) cholesterol have the highest risk for myocardial infarction and atherosclerotic cardiovascular disease (ASCVD), according to the results of a recent study. Lipid-lowering therapies are also effective for reducing cardiovascular events in individuals aged 75 years or older.

The researchers utilized data from the Copenhagen General Population Study (CGPS) to analyze individuals aged between 20 to 100 years who did not have ASCVD or diabetes at baseline. Participants had not taken statins previously. A total of 91,131 individuals had been enrolled in CGPS between November 2003 and February 2015.

The results indicated that 1515 participants had had their first myocardial infarction and 3389 had had ASCVD diagnosed in the 7.7-year follow-up period.

The risk was increased for myocardial infarction per 1.0 mmol/L increase in LDL cholesterol, with a hazard ratio of 1.34, and for ASCVD per 1.0 mmol/L increase in LDL cholesterol, with a hazard ratio of 1.16. The risk was high in all age groups, but especially among those aged 70 to 100 years.

“Risk of myocardial infarction was also increased with a 5.0 mmol/L or higher LDL cholesterol versus less than 3.0 mmol/L in individuals aged 80-100 years (HR 2.99, 95% CI 1.71–5.23) and in those aged 70-79 years (HR 1.82, 1.20–2.77),” the researchers wrote.

Disease events for both myocardial infarction and ASCVD were highest in those aged 70 to 100 years. The number of disease events for these 2 were lower with younger age. Conversely, the number needed to treat in 5 years to prevent 1 of these events was lowest for individuals aged 70 to 100 years and increased with younger age, given the individuals were prescribed a moderate-intensity statin.

“In a contemporary primary prevention cohort, people aged 70-100 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and [ASCVD] and the lowest estimated [number needed to treat] in 5 years to prevent one event,” the study authors wrote. “Our data are important for preventive strategies aimed at reducing the burden of myocardial infarction and [ASCVD] in the growing population aged 70-100 years.”

—Leigh Precopio

Reference:

Mortensen MB, Nordestgaard MG. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: a contemporary primary prevention cohort. Lancet. Published online November 10, 2020. doi:10.1016/S0140-6736(20)32233-9