Lipid-Lowering Therapy after an Acute Myocardial Infarction in Older Adults: 5-Year Outcomes

Circulation: Cardiovascular Quality and Outcomes: Published Apr 2024


This study used data from the FAST-MI program to examine the effect of lipid-lowering therapy (LLT) (atorvastatin ≥40 mg or equivalent or any combination of a statin and ezetimibe) intensity on long-term mortality in 2258 patients aged 80 years or older who experienced an acute myocardial infarction.

High-dose LLT was associated with a significantly lower risk of 5-year mortality than that of no LLT, whereas conventional-intensity LLT showed no significant association with mortality. Propensity score matching confirmed these findings, showing a 22% lower risk of mortality with high-intensity LLT.

This study suggests that older patients should not be denied high-intensity Lipid-Lowering Therapy (LLT) after an acute myocardial infarction as it is linked to a reduced risk of all-cause mortality.

Doctors Liked to Read More

Background: 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.

Read In Details

This is for informational purposes only. You should consult your clinical textbook for advising your patients.