Effects of High-Dose Atorvastatin in Patients ≥65 Years of Age With Acute Coronary Syndrome (from the Myocardial Ischemia Reduction With Aggressive Cholesterol Lowering [MIRACL] Study)

• Published in: The American journal of cardiology Vol. 99; no. 5; pp. 632 - 635
• Main Authors: Olsson, Anders G., MD, PhD, Schwartz, Gregory G., MD, PhD, Szarek, Michael, MS, Luo, Don, PhD, Jamieson, Michael J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2007; Elsevier; Elsevier Limited
• Subjects: Age Factors; Aged; Aged, 80 and over; Atorvastatin Calcium; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary heart disease; Coronary vessels; Disorders of blood lipids. Hyperlipoproteinemia; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug therapy; Female; Heart; Heptanoic Acids - administration & dosage; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Inhibitor drugs; Lipids; Male; Medical sciences; MEDICIN; MEDICINE; Metabolic diseases; Middle Aged; Myocardial Ischemia - prevention & control; Myocarditis. Cardiomyopathies; Older people; Patient safety; Pyrroles - administration & dosage; Retrospective Studies; Syndrome; Treatment Outcome; Myocardial infarction; Cardiovascular disease; Metabolic diseases; Myocardial ischemia; Lipids; Patient; Hyperlipoproteinemia; Lipoprotein; Hypocholesterolemic agent; Coronary heart disease; Myocardial disease; Phlebology; Cholesterol; Vascular disease; Hypercholesterolemia; Atorvastatin; Circulatory system; Dyslipemia; Cardiology; Variant angina; High dose
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2006.09.111

After acute coronary syndromes (ACSs), older patients are particularly susceptible to early complications, including death and recurrent ACS. Lipid management guidelines do not differentiate elderly from younger patients, and lack of evidence for statin benefits in older patients has led to underutilization of statins in the elderly. The MIRACL study randomized 3,086 patients to 16 weeks of 80 mg/day of atorvastatin or placebo 24 to 96 hours after ACS and demonstrated significant decreases in the combined primary end point (nonfatal acute myocardial infarction, resuscitated cardiac arrest, recurrent symptomatic myocardial ischemia). This post hoc analysis compared benefits of 80 mg of atorvastatin in older (≥65 years) versus younger (<65 years) patients. Event rates were approximately two- to threefold higher in older than in younger patients. Treatment-by-age heterogeneity testing indicated no difference in treatment effect by age for any of the primary or secondary end points, and relative risk decreases in the primary end point with atorvastatin versus placebo were similar in younger and older patients (22% vs 14%, respectively). The safety profile of atorvastatin was similar between the 2 age groups. In conclusion, these results and a greater immediate cardiovascular risk in older patients argue for early, intensive atorvastatin therapy as routine practice after ACS.