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

TL;DR

This study shows that combining moderate-intensity statins with ezetimibe safely lowers cholesterol in elderly patients with heart disease.

Contribution

The study introduces a safer lipid-lowering regimen for elderly patients with ASCVD using moderate-intensity statins plus ezetimibe.

Findings

LDL cholesterol levels dropped by 39.6% in elderly patients after six months of treatment.

Only 5% of patients experienced major cardiovascular events, and adverse effects were rare.

High medication adherence was observed, with 97.3% of patients continuing treatment.

Abstract

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.