Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Danish Cancer Institute, Copenhagen, Denmark.
J Am Coll Cardiol. 2023 Oct 3;82(14):1381-1391. doi: 10.1016/j.jacc.2023.07.027.
Reducing low-density lipoprotein (LDL) cholesterol with lipid-lowering therapy has consistently been shown to lower the risk of cardiovascular disease in primary prevention trials where the majority of individuals are aged <70 years. For older individuals, however, evidence is less clear.
In this study, the authors sought to compare the clinical effectiveness of lowering LDL cholesterol by means of lipid-lowering therapy for primary prevention of cardiovascular disease among older and younger individuals in a Danish nationwide cohort.
We included individuals aged ≥50 years who had initiated lipid-lowering therapy from January 1, 2008, to October 31, 2017, had no history of atherosclerotic cardiovascular disease, and had a baseline and a within-1-year LDL cholesterol measurement. We assessed the associated risk of major vascular events among older individuals (≥70 years) by HRs per 1 mmol/L reduction in LDL cholesterol compared with younger individuals (<70 years).
For both the 16,035 older and the 49,155 younger individuals, the median LDL cholesterol reduction was 1.7 mmol/L. Each 1 mmol/L reduction in LDL cholesterol in older individuals was significantly associated with a 23% lower risk of major vascular events (HR: 0.77; 95% CI: 0.71-0.83), which was equal to that of younger individuals (HR: 0.76; 95% CI: 0.71-0.80; P value for difference = 0.79). Similar results were observed across all secondary analyses.
Our study supports a relative clinical benefit of lowering LDL cholesterol for primary prevention of major vascular events in individuals aged ≥70 years similarly as in individuals aged <70 years.
降脂治疗降低低密度脂蛋白（LDL）胆固醇一直被证明可降低一级预防试验中心血管疾病的风险，这些试验中的大多数个体年龄<70 岁。然而，对于年龄较大的个体，证据不太明确。
在这项研究中，作者旨在比较降脂治疗降低 LDL 胆固醇在丹麦全国队列中年龄较大和较小个体中用于一级预防心血管疾病的临床效果。
我们纳入了 2008 年 1 月 1 日至 2017 年 10 月 31 日期间开始降脂治疗、无动脉粥样硬化性心血管疾病病史且基线和 1 年内有 LDL 胆固醇测量值的年龄≥50 岁的个体。我们评估了年龄较大（≥70 岁）个体中每 1mmol/L LDL 胆固醇降低与年龄较小（<70 岁）个体相比主要血管事件的相关风险，以 HR 表示。
对于年龄较大的 16035 名个体和年龄较小的 49155 名个体，LDL 胆固醇降低的中位数为 1.7mmol/L。年龄较大个体中每 1mmol/L LDL 胆固醇降低与主要血管事件风险降低 23%显著相关（HR：0.77；95%CI：0.71-0.83），与年龄较小个体（HR：0.76；95%CI：0.71-0.80；P 值为差异=0.79）相当。所有次要分析中均观察到类似结果。
我们的研究支持降低 LDL 胆固醇对于年龄≥70 岁个体一级预防主要血管事件具有相对临床获益，与年龄<70 岁个体相似。
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