Evaluating the Safety and Efficacy of Moderate-Intensity Statin Combined With Ezetimibe in Elderly Patients With Atherosclerotic Cardiovascular Disease.

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent in the elderly and often requires intensive lipid-lowering therapy. However, high-intensity statins may lead to adverse effects such as myopathy, liver enzyme elevations, or cognitive changes in older adults. The objective of this study was to evaluate the safety and efficacy of moderate-intensity statin therapy in combination with ezetimibe for lipid control and cardiovascular risk reduction in elderly patients with established ASCVD.

METHODS

This retrospective, observational cohort study was conducted at Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, from January 2023 to June 2023. A total of 221 elderly patients (age ≥60 years) with established ASCVD were included in the study.  Results: The mean low-density lipoprotein cholesterol (LDL-C) level significantly decreased from 129.4 ± 18.7 mg/dL at baseline to 78.2 ± 16.4 mg/dL at six months (p < 0.001), representing a 39.6% reduction. LDL-C <70 mg/dL was achieved in 153 patients (69.2%), and <100 mg/dL in 202 patients (91.4%). Adverse events were infrequent: myalgia occurred in seven patients (3.2%), elevated liver enzymes in five patients (2.3%), and creatine kinase increase in four patients (1.8%), with no cases of rhabdomyolysis. Medication adherence was high, with 215 patients (97.3%) remaining on therapy, and only three patients (1.4%) discontinued treatment due to adverse effects. A total of 11 patients (5.0%) experienced major adverse cardiovascular events (MACE) during follow-up.

CONCLUSION

Combining moderate-intensity statins with ezetimibe is an effective and safe lipid-lowering strategy for elderly patients with ASCVD. The regimen achieved high rates of LDL-C goal attainment with minimal side effects and good adherence, making it a practical alternative to high-intensity statin monotherapy in this population.