Lipid modification in the elderly using the combination of a statin and a cholesterol absorption inhibitor

Abstract

While the optimal lipid-lowering treatment to reduce cardiovascular disease (CVD) risk in elderly patients has not been definitively established, evidence so far indicates that reducing low-density lipoprotein cholesterol (LDL-C) should be a primary goal, as with other patient groups. The VYTELD (VYTorin in the ELDerly) study – a multicenter, 12-week, randomized, double-blind trial – evaluated the efficacy and safety of combination therapy comprised of ezetimibe plus simvastatin (eze/simva) versus atorvastatin in 1289 hypercholesterolemic patients aged ≥ 65 years. For all prespecified comparisons, patients randomized to eze/simva were found to have significantly greater percentage decreases in LDL-C and were significantly more likely to achieve LDL-C target levels compared with those on atorvastatin monotherapy (p < 0.05 to < 0.001). Also, the proportions of subjects reaching secondary biochemical targets were similarly greater with eze/simva than with atorvastatin monotherapy for all prespecified comparisons (p < 0.01 to < 0.001). Finally, there were no differences in tolerability between the treatments. The authors concluded that in patients aged ≥ 65 years, the eze/simva combination provided significantly greater improvements in key lipid variables, with a larger proportion of subjects reaching target LDL-C compared with atorvastatin monotherapy. Despite these promising short-term results, the longer-term safety and efficacy of combination treatment across diverse populations requires further evaluation.

Keywords::

• cardiovascular risk
• cholesterol absorption inhibition
• low-density lipoprotein (LDL) cholesterol
• statin therapy

Acknowledgements

Supported by the JJ Wolfe Distinguished Medical Research Chair at the University of Western Ontario, the Edith Schulich Vinet Canada Research Chair in Human Genetics (Tier I), the MG Blackburn Chair in Cardiovascular Research, and operating grants from the CIHR (MOP-13430, MOP-79523, CTP-79853), the Heart and Stroke Foundation of Ontario (NA-6059, T-6018, PRG-4854), and by Genome Canada through the Ontario Genomics Institute.

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