Abstract 10795: Alirocumab and Cardiovascular Outcomes in Older Patients After an Acute Coronary Syndrome: An ODYSSEY OUTCOMES Trial Analysis

BackgroundStatins reduce ischemic cardiovascular risk irrespective of age, but the evidence is less strong for older patients. The ODYSSEY OUTCOMES trial compared alirocumab (ALI) with placebo, added to high-intensity or maximum-tolerated statin treatment, after ACS in 18,924 patients. ALI reduced the primary composite endpoint (MACE) of death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke or unstable angina requiring hospitalization.MethodsIn this prespecified analysis comparing the effect of ALI vs placebo on outcomes, we evaluated the impact of age at randomization on the occurrence of ischemic events and the relative impact of ALI vs placebo on these events. Patients were stratified according to age at enrollment (< vs ≥ 65 years). In addition, age was treated as a continuous variable in regression models.ResultsPatients >65 years of age represented 27% of the population (Figure). For the primary outcome, there was no difference in the relative risk reductions between patients ≥65 vs 65 years (Figure). Age did not affect the relative risk reductions with ALI. However, absolute risk reduction increased with advancing age, with number-needed-to-treat for MACE at 3 years of 43 (25-186) for a 45-year-old patient vs 26 (15-97) or 12 (6-81) for patients at age 75 or 85. Although adverse events were observed more frequently in older patients, there were no differences between ALI and placebo.ConclusionIn patients with recent ACS, ALI improves outcomes irrespective of age. Increasing treatment benefit but not harm with advancing age suggests that marked LDL-C lowering is an important secondary preventive intervention for older patients.