211: Low-Density Lipoprotein Cholesterol Lowering by High-Efficacy Statins: Are Older Women at an Advantage?

Abstract

Synopsis: In the PROSPER trial, high-risk, older women had higher low-density lipoprotein cholesterol (LDL-C) levels than men at baseline (154 vs. 139 mg/dL), resulting in higher on-treatment LDL-C despite marginally greater response to statin treatment. Purpose: We assessed the more effective statins by sex and age subgroups in a trial of high-risk patients. Methods: In the SOLAR trial (4522US/0003), 1632 patients with LDL-C 130 –250 mg/dL were randomized to rosuvastatin (RSV) 10 mg, atorvastatin (ATV) 10 mg, or simvastatin (SMV) 20 mg for 6 weeks. LDL-C reductions from baseline were compared between treatment groups by ANCOVA and LDL-C goal attainment by logistic regression. Results: Mean age was 62y; the cohort was 58% male and 91% had CHD or CHD risk-equivalents. Mean baseline LDL-C for women and men 65y was 168 and 166 mg/dL, respectively. For women and men 65y, mean baseline LDL-C was 176 and 164 mg/dL. In all 4 subgroups, % LDL-C reduction and % of patients achieving LDL 100 mg/dL were greater for RSV than for ATV or SMV (Table). Older women achieved greater LDL-C reduction than younger women, but goal attainment was not more frequent, apparently due to higher baseline LDL-C levels. Of older women and men, 67% and 73% respectively achieved LDLC 100 mg/dL with RSV 10 mg. Conclusions: Baseline LDL-C was elevated in older women, but increased statin response produced final LDL-C values similar to those of younger women. Goal attainment in older patients suggested a gender difference that should be confirmed in further studies.