JAMA Cardiology Author Interviews Simvastatin-Ezetimibe Compared With Simvastatin Monotherapy Among Patients 75 Years or Older
Jul 17, 2019
Richard G. Bach, a leading cardiologist, and Antonio M. Gotto, a prominent expert in dyslipidemia, explore the effects of combining simvastatin with ezetimibe for patients aged 75 and older. They discuss significant LDL reductions and a greater absolute risk reduction in older patients, emphasizing the treatment's effectiveness. Gotto highlights the importance of shared decision-making in guidelines for elderly care. Both guests conclude there are no increased safety concerns, stressing the need for more intensive lipid-lowering strategies in this demographic.
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Elderly Subgroup Was Large And Informative
- The IMPROVE-IT trial enrolled >18,000 post-ACS patients with no upper age limit, including ~2,800 aged ≥75.
- Adding ezetimibe to simvastatin lowered LDL substantially and produced larger absolute risk reduction in the elderly.
Much Greater Absolute Benefit In ≥75-Year-Olds
- In patients ≥75, simvastatin+ezetimibe reduced LDL to ~49 mg/dL and yielded ~9% absolute risk reduction at seven years.
- The absolute benefit in older patients was markedly greater than in younger groups.
NNT Is Tenfold Better In Older Patients
- Number needed to treat differed dramatically: NNT ≈125 for <75 but ≈11 for ≥75 to prevent one composite event.
- This highlights much higher absolute risk and greater population impact in the elderly.