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
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  • 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


  • Study included limited number of very elderly patients.