To the Editor We congratulate Bach et al1 for their excellent analysis of the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) in patients older than 75 years. Older individuals represent the largest group of hospitalized patients with an acute coronary syndrome, and that number continues to grow with the aging of the population. In patients older than 75 years, the number needed to treat with ezetimibe on top of simvastatin is only 11 to prevent 1 additional primary end point, while the number needed to treat is 125 in those younger than 75 years. It illustrates the preventive capacity of adding a cholesterol absorption inhibitor in this particular patient group. These findings do not come as a surprise, as cholesterol metabolism changes during the lifetime; midlife is characterized by high synthesis and low absorption, whereas cholesterol synthesis decreases with increasing age.2
Weingärtner O, Sijbrands EJG, Lütjohann D. Interpreting the Benefit of Simvastatin-Ezetimibe in Patients 75 Years or Older. JAMA Cardiol. 2020;5(2):234. doi:10.1001/jamacardio.2019.5197
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