Acute coronary syndrome: alirocumab improves cardiovascular outcomes irrespective of age

  • Sinnaeve PR & al.
  • Eur Heart J
  • 16 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Addition of alirocumab to maximally tolerated high-intensity statins significantly reduced the risk for recurrent ischaemic events and all-cause death in patients after an acute coronary syndrome (ACS) irrespective of age and without significant safety issues in older patients.
  • Absolute treatment benefit of alirocumab increased with advancing age indicating that lipid-lowering therapy beyond statins may be an important secondary preventive intervention for older patients after ACS.

Why this matters

  • Findings might be considered in future guideline recommendations for lipid-lowering therapies in older patients.

Study design

  • Prespecified analysis of ODYSSEY OUTCOMES compared the effect of alirocumab vs placebo in 18,924 patients with recent ACS according to age group (≥65/
  • Primary outcome: major adverse cardiovascular events (MACEs; composite of death from coronary heart disease, non-fatal myocardial infarction, fatal or non-fatal ischaemic stroke, or unstable angina requiring hospitalisation).
  • Funding: Sanofi and others.

Key results

  • No significant difference was observed between alirocumab vs placebo in the risk for MACEs in patients aged:
    • ≥65 vs interaction=.19) and
    • ≥75 vs interaction=.19).
  • The risk for MACE reduced with alirocumab with numbers-needed-to-treat for MACE at 3 years of 43 (range, 25-186) at age 45 years, 26 (range, 15-97) at age 75 years and 12 (range, 6-81) for those at age 85 years.
  • No significant difference was observed for adverse and serious adverse events between alirocumab and placebo in patients aged ≥65 or

Limitations

  • Study included limited number of very elderly patients.