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Treat-to-target or high-intensity statin treatment in older adults with coronary artery disease: a post hoc analysis of the LODESTAR trial.
Lee, Seung-Jun; Lee, Jin-Bae; Yang, Tae-Hyun; Kang, Woong Chol; Lee, Jong-Young; Lee, Yong-Joon; Hong, Sung-Jin; Ahn, Chul-Min; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Hong, Bum-Kee; Choi, Donghoon; Yoon, Junghan; Jang, Yangsoo; Hong, Myeong-Ki.
Afiliación
  • Lee SJ; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
  • Lee JB; Daegu Catholic University Medical Center, Duryugongwon-ro 17-gil, Nam-gu, 42472, Daegu, Korea.
  • Yang TH; Inje University Busan Paik Hospital, Bokji-ro 75, Busanjin-gu, 47392, Busan, Korea.
  • Kang WC; Gachon University College of Medicine, Namdong-daero 774 beon-gil, Namdong-gu, 21565, Incheon, Korea.
  • Lee JY; Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Saemunan-ro, Jongno-gu, 03181, Seoul, Korea.
  • Lee YJ; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
  • Hong SJ; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
  • Ahn CM; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
  • Kim JS; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
  • Kim BK; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
  • Ko YG; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
  • Hong BK; Gangnam Severance Hospital, Eonju-ro, Gangnam-gu, 06273, Seoul, Korea.
  • Choi D; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
  • Yoon J; Wonju Severance Christian Hospital, Ilsan-ro, 26426, Wonju, Korea.
  • Jang Y; CHA University College of Medicine, Yatap-ro, Bundang-gu, 13497, Seongnam, Korea.
  • Hong MK; Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea.
Age Ageing ; 53(7)2024 Jul 02.
Article en En | MEDLINE | ID: mdl-38965031
ABSTRACT

BACKGROUND:

The optimal statin treatment strategy that is balanced for both efficacy and safety has not been clearly determined in older adults with coronary artery disease (CAD).

METHODS:

In the post hoc analysis of the LODESTAR (low-density lipoprotein cholesterol-targeting statin therapy versus intensity-based statin therapy in patients with coronary artery disease) trial, the impact between a treat-to-target strategy versus a high-intensity statin therapy strategy was compared in older adults (aged 75 years or older). The goal of treat-to-target low-density lipoprotein cholesterol (LDL-C) level was 50-70 mg/dl. The primary endpoint comprised the three-year composite of all-cause death, myocardial infarction, stroke or coronary revascularisation.

RESULTS:

Among 4,400 patients with CAD enrolled in the LODESTAR trial, 822 (18.7%) were aged 75 years or older. Poor clinical outcomes and risk factors for atherosclerosis were more frequently observed in older adults than in younger population (<75 years old). Among these older adults with CAD, the prescription rate of high-intensity statin was significantly lower in the treat-to-target strategy group throughout the study period (P < 0.001). The mean LDL-C level for three years was 65 ± 16 mg/dl in the treat-to-target strategy group and 64 ± 18 mg/dl in the high-intensity statin group (P = 0.34). The incidence of primary endpoint occurrence was 10.9% in the treat-to-target strategy group and 12.0% in the high-intensity statin group (hazard ratio 0.92, 95% confidence interval 0.61-1.38, P = 0.69).

CONCLUSIONS:

High-intensity statin therapy is theoretically more necessary in older adults because of worse clinical outcomes and greater number of risk factors for atherosclerosis. However, the primary endpoint occurrence with a treat-to-target strategy with an LDL-C goal of 50-70 mg/dl was comparable to that of high-intensity statin therapy and reduced utilisation of a high-intensity statin. Taking efficacy as well as safety into account, adopting a tailored approach may be considered for this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov, NCT02579499.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Inhibidores de Hidroximetilglutaril-CoA Reductasas / LDL-Colesterol Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Age Ageing Año: 2024 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Inhibidores de Hidroximetilglutaril-CoA Reductasas / LDL-Colesterol Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Age Ageing Año: 2024 Tipo del documento: Article