Although there have been studies regarding intensive lowering of low-density lipoprotein (LDL)-cholesterol with high intensity statins in patients with cardiovascular disease, elderly patients were either excluded or accounted only a small portion of study subjects. Therefore, this study sought to compare the clinical outcomes according to the LDL-cholesterol therapy strategy (intensive targeting \[LDL-cholesterol goal of \<55mg/dL\] vs. conventional therapy \[moderate intensity statin therapy\]) in elderly patients with ≥75 years and documented cardiovascular disease.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
1,200
Intensive lipid lowering therapy with LDL-cholesterol goal of \<55mg/dL. Atorvastatin 5, 10, 20, 40, and 80mg are allowed to use and ezetimibe or PCSK-9 inhibitor may be considered in patients who could not achieve target LDL-cholesterol level even with the maximum dose of study drugs (atorvastatin 80mg) by the discretion of the investigator.
Only moderate intensity statin therapy (atorvastatin 5, 10, and 20mg ) are allowed. Ezetimibe or PCSK-9 inhibitor is not allowed to use.
Yonsei University Health System, Severance Hospital
Seoul, South Korea
Clinical efficacy of intensive lipid-lowering therapy
Primary Outcome - Composite of cardiovascular death, non-fatal myocardial infarction (MI), non-fatal stroke, coronary revascularization, and hospitalization for unstable angina
Time frame: 3 years
Cardiovascular death
Occurrence of cardiovascular death during the 3-year follow-up period
Time frame: 3 years
Non-fatal MI
Occurrence of non-fatal MI during the 3-year follow-up period
Time frame: 3 years
Non-fatal stroke
Occurrence of non-fatal stroke during the 3-year follow-up period
Time frame: 3 years
Coronary revascularization
Occurrence of coronary revascularization during the 3-year follow-up period
Time frame: 3 years
Hospitalization for unstable angina
Occurrence of hospitalization for unstable angina during the 3-year follow-up period
Time frame: 3 years
Composite of cardiovascular death, non-fatal MI, and non-fatal stroke
First occurrence of cardiovascular death, non-fatal MI, or non-fatal stroke during the 3-year follow-up period
Time frame: 3 years
Composite of cardiovascular death, non-fatal MI, non-fatal stroke, and coronary revascularization
First occurrence of cardiovascular death, non-fatal MI, non-fatal stroke, or coronary revascularization during the 3-year follow-up period
Time frame: 3 years
Composite of cardiovascular death, non-fatal MI, and coronary revascularization
First occurrence of cardiovascular death, non-fatal MI, or coronary revascularization during the 3-year follow-up period
Time frame: 3 years
Composite of all-cause death, non-fatal MI, non-fatal stroke, coronary revascularization, and hospitalization for unstable angina
First occurrence of all-cause death, non-fatal MI, non-fatal stroke, coronary revascularization, or hospitalization for unstable angina during the 3-year follow-up period
Time frame: 3 years
Rate of cross-over into the non-allocated therapy strategy
Rate of cross-over into the non-allocated therapy strategy at 1 month, and 1, 2, and 3 years after enrollment
Time frame: 3 years
New-onset diabetes mellitus
Occurrence of new-onset diabetes mellitus during the 3-year follow-up period
Time frame: 3 years
Worsening of glycemic control
Occurrence of worsening of glycemic control during the 3-year follow-up period
Time frame: 3 years
Change of homeostasis model assessment of insulin resistance (HOMA-IR) index
Change in HOMA-IR index from baseline at 1, 2, and 3 years after enrollment
Time frame: 3 years
Occurrence of statin-associated muscle symptoms (SAMS) requiring change of therapy regimen or dosage
Occurrence of SAMS requiring change of therapy regimen or dosage during the 3-year follow-up period
Time frame: 3 years
Elevation of muscle enzymes
Occurrence of elevation of muscle enzymes (CPK level \> 4 x UNL) during the 3-year follow-up period
Time frame: 3 years
Elevation of hepatic enzymes
Occurrence of elevation of hepatic enzymes (AST, ALT, or both levels ≥ 3 x UNL) during the 3-year follow-up period
Time frame: 3 years
Elevation of serum creatinine level
Occurrence of elevation of serum creatinine level (\>50% increase from baseline) during the 3-year follow-up period
Time frame: 3 years
Change of proteinuria
Change in proteinuria assessed by urinalysis from baseline at 1, 2, and 3 years after enrollment
Time frame: 3 years
Diagnosis of cancer
Occurrence of diagnosis of cancer during the 3-year follow-up period
Time frame: 3 years
Operation due to cataract
Occurrence of operation due to cataract during the 3-year follow-up period
Time frame: 3 years
Major bleeding (BARC 2, 3, or 5)
Occurrence of major bleeding (BARC 2, 3, or 5) during the 3-year follow-up period
Time frame: 3 years
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