title: Impact of atorvastatin among older and younger patients in the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm.
abstract: OBJECTIVE
  Older patients experience higher rates of cardiovascular disease than younger patients, but may be undertreated with statins due to doubts about efficacy and safety. The Lipid-Lowering Arm of the Anglo-Scandinavian Cardiac Outcomes Trial allowed an evaluation of the efficacy and safety of atorvastatin among older (≥ 65 years) and younger (<65 years) patients with hypertension.
  
  
  METHODS
  A total of 10 305 patients with hypertension, at least three other cardiovascular risk factors, total cholesterol concentrations of 251 mg/dl or less, and no known coronary heart disease (CHD) were randomized to receive atorvastatin 10 mg or placebo. The primary endpoint was a composite of nonfatal myocardial infarction and fatal CHD.
  
  
  RESULTS
  There were 4445 patients in the older group (mean 71 years) and 5860 patients (mean 57 years) in the younger group. Among those taking placebo, the older group experienced a higher rate of primary endpoints than the younger group (11.7 vs. 7.6 events per 1000 patient years, respectively). After a median follow-up of 3.3 years, the primary endpoint was reduced by a similar proportion in both older and younger patients (37 vs. 33%, respectively). Although older patients reported more serious adverse events than younger patients, there were no significant differences between atorvastatin and placebo within each age group.
  
  
  CONCLUSIONS
  Atorvastatin reduced the risk of major cardiovascular events to a similar relative extent in both older and younger patients with treated hypertension. However, given that event rates were higher in older patients, the absolute benefits of atorvastatin were greater for older than younger patients.
authors.affiliation: Barts and The London, Queen Mary's School of Medicine and Dentistry, UK. d.j.collier@qmul.ac.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Collier
authors.forename: Neil R
authors.initials: NR
authors.lastname: Poulter
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Peter S
authors.initials: PS
authors.lastname: Sever
authors.forename: Hans
authors.initials: H
authors.lastname: Wedel
authors.forename: Jan
authors.initials: J
authors.lastname: Buch
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Caulfield
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006538:Heptanoic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D011758:Pyrroles; D000069059:Atorvastatin