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