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Lipid-Lowering Therapy After an Acute Myocardial Infarction in Older Adults: 5-Year Outcomes
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Older people are underrepresented in randomized trials. The association between lipid-lowering therapy (LLT) and its intensity after acute myocardial infarction and long-term mortality in this population deserves to be assessed.
METHODS
The FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) program consists of nationwide French surveys including all patients admitted for acute myocardial infarction ≤48 hours from onset over a 1- to 2-month period in 2005, 2010, and 2015, with long-term follow-up. Numerous data were collected and a centralized 10-year follow-up was organized. The present analysis focused on the association between prescription of LLT (atorvastatin ≥40 mg or equivalent, or any combination of statin and ezetimibe) and 5-year mortality in patients aged ≥80 years discharged alive. Cox multivariable analysis and propensity score matching were used to adjust for baseline differences.
RESULTS
Among the 2258 patients aged ≥80 years (mean age, 85±4 years; 51% women; 39% ST-segment elevation myocardial infarction; 58% with percutaneous coronary intervention), 415 were discharged without LLT (18%), 866 with conventional doses (38%), and 977 with high-dose LLT (43%). Five-year survival was 36%, 47.5%, and 58%, respectively. Compared with patients without LLT, high-dose LLT was significantly associated with lower 5-year mortality (adjusted hazard ratio, 0.78 [95% CI, 0.66-0.92]), whereas conventional-intensity LLT was not (adjusted hazard ratio, 0.93 [95% CI, 0.80-1.09]). In propensity score-matched cohorts (n=278 receiving high-intensity LLT and n=278 receiving no statins), 5-year survival was 52% with high-intensity LLT at discharge and 42% without statins (hazard ratio, 0.78 [95% CI, 0.62-0.98]).
CONCLUSIONS
In these observational cohorts, high-intensity LLT at discharge after acute myocardial infarction was associated with reduced all-cause mortality at 5 years in an older adult population. These results suggest that high-intensity LLT should not be denied to patients on the basis of old age.
Additional Info
Disclosure statements are available on the authors' profiles:
Association of Use and Dose of Lipid-Lowering Therapy Post Acute Myocardial Infarction With 5-Year Survival in Older Adults
Circ Cardiovasc Qual Outcomes 2024 Apr 29;[EPub Ahead of Print], A Fayol, F Schiele, J Ferrières, E Puymirat, V Bataille, V Tea, C Chamandi, F Albert, G Lemesle, G Cayla, O Weizman, T Simon, N DanchinFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Limited data exist regarding the association between lipid-lowering therapy (LLT) intensity and long-term mortality in older adults (aged ≥80 years) after a myocardial infarction.
This study investigated the relationship between LLT intensity (atorvastatin ≥40 mg or equivalent or any combination of a statin and ezetimibe) and the rate of 5-year mortality in patients aged 80 years or older discharged alive enrolled in the FAST-MI program — a registry of nationwide French surveys of all patients admitted for acute myocardial infarction 48 hours or less from onset over a 1- to 2-month period in 2005, 2010, and 2015, with long-term follow-up.
Among the 2258 patients older than 80 years included (mean age, 85 ± 4 years; women, 51%; 39% had ST-segment elevation myocardial infarction; and 58% underwent PCI), 415 were discharged without LLT (18%), 866 with conventional doses (38%), and 977 with high-dose LLT (43%). The rate of 5-year survival was 36.0%, 47.5%, and 58.0%, respectively. Compared with no LLT, high-dose LLT was significantly associated with a lower rate of 5-year mortality (aHR, 0.78; 95% CI, 0.66–0.92) whereas conventional-intensity LLT was not (aHR, 0.93; 95% CI, 0.80–1.09). In propensity score–matched cohorts (278 receiving high-intensity LLT and 278 receiving no statins), the 5-year survival rate was 52% with high-intensity LLT at discharge and 42% without statins (HR, 0.78; 95% CI, 0.62–0.98).
The take-home message is that high-intensity LLT at discharge after an acute myocardial infarction was associated with a reduced rate of all-cause mortality at 5 years in an older adult population.Older age per se should not constitute an obstacle to the prescription of high-intensity LLT in patients admitted for myocardial infarction.