Sooner certainly seems to be better than later when it comes to treating LDL-C levels with the PCSK9 inhibitor evolocumab (Amgen’s Repatha), and according to a recent JACC study, that’s especially true for older patients.
- People aged ≥75 years make up ~65% of all deaths linked to cardiovascular disease, with age being one of the primary risk factors for ASCVD.
- However, the potential for low effectiveness and unfavorable safety profiles has led to fewer guidelines for treating older patients using non-statin lipid lowering drugs.
Putting age before beauty, researchers conducted a prespecified analysis of the FOURIER-OLE study and found that among roughly 6.6k patients, evolocumab reduced the study’s composite primary endpoint of CV death and complications by twice as much in older patients (≥75) than in younger ones (<75) compared to placebo.
- Earlier evolocumab initiation reduced the rate of CV death, MI, stroke, hospitalization, or revascularization by 21% in older patients and 14% in younger patients.
- Evolocumab achieved over 2x greater risk reductions in older patients (5.4% vs. 2.3%), leading to a far lower number needed to treat to avoid one event (19 vs. 44).
- Incidence rates of safety events appeared similar across both age groups, suggesting that the PCSK9i is safe for older patients.
Despite evolocumab’s effectiveness, current AHA/ACC guidelines don’t list non-statin lipid lowering agents as a potential prevention for ASCVD, leading to less prescriptions and availability for these therapies.
- At least insurance isn’t an issue. With evolocumab now covered under Medicare, the drug’s once $600 list price isn’t what most patients are paying for it.
The Takeaway
When you consider that older patients see nearly twice the benefit with PCSK9 inhibitors, guidelines that shy away from non-statin LDL-C therapy might not make sense. After all, it’s not just about increasing patient lifespans when healthspan is on the table too.
