Simvastatin-Ezetimibe Combo Effective in Elderly ACS Patients

A new analysis suggests that elderly patients may benefit from a high-intensity simvastatin-ezetimibe combination after acute coronary syndrome.

The paper, published in JAMA Cardiology, included a look at patients who were 75 years of age or older with stabilized acute coronary syndrome (ACS). IMPROVE-IT included over 18,000 patients who were treated with simvastatin-ezetimibe combination therapy or simvastatin alone. The results of the study have been previously published. The current analysis focused on the most elderly patients in the trial population.

After ACS, #elderly patients may benefit from simvastatin-ezetimibe vs simvastatin alone as a higher-intensity therapy to lower lipids with preserved safety https://t.co/el6UwRWESJ

— JAMA Cardiology (@JAMACardio) July 17, 2019

According to the analysis results, the combination therapy ended up providing a reduction in rates of the primary endpoint, with the greatest risk reduction (8.7%) seen in patients over 75 years or older (HR=0.80; 95% CI, 0.70 to 0.90; P=0.02 for interaction). There were smaller risk reductions in patients aged under 65 years (HR=0.96; 95% CI, 0.87 to 1.06), and in patients aged 65-74 years (HR=0.96; 95% CI, 0.87 to 1.06). No changes in adverse rates were reported between study cohorts.

“These results may have implications for guideline recommendations regarding lowering of lipid levels in the elderly,” the researchers wrote.

Christopher Cannon, MD, of Harvard Medical School and a cardiologist at Brigham and Women’s Hospital in Boston, told DocWire News that these analysis results are encouraging for older patients.

“The combination of ezetimibe and statin lead to an absolute risk reduction of 9% for the primary endpoint (the overall risk reduction was 2% absolute in the trial as a whole),” Dr. Cannon said. “Of note, this group (75 years of age or more) started the trial with an average age of 79 and were followed for average of six years (until age 85) and they saw all this benefit! This tells me that we need to treat our elderly patients, as they benefit greatly.”

In IMPROVE-IT you only needed to treat 11 patients 75 years or older with simvastatin-ezetimibe to prevent 1 eventdaysxa new analysis https://t.co/zdt7hGwD5S

— Prof Derek Connolly (@DrDerekConnolly) July 18, 2019

In IMPROVE-IT, a post ACS trial, the pts > age 75 received most benefit (absolute risk redn) – with addition of ezetimibe to simvastatin & it was not associated with any increase in safety issues https://t.co/QcRtYiN1it

— Thomas Dayspring (@Drlipid) July 18, 2019

Do the benefits of intensive LDL lowering outweigh risks of AEs in those age 75+ with ASCVD? Yes. Time to improve care (and the guidelines). Simvastatin-Ezetimibe Compared With Simvastatin Among Patients 75 Years or Older https://t.co/FAL6UEkmrX @cpcannon @rblument1 @JAMACardio

— Gregg Fonarow MD (@gcfmd) July 18, 2019