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. 2025 Jun 20;17(6):e86404.
doi: 10.7759/cureus.86404. eCollection 2025 Jun.

Evaluating the Safety and Efficacy of Moderate-Intensity Statin Combined With Ezetimibe in Elderly Patients With Atherosclerotic Cardiovascular Disease

Muhammad Usman Khalid  1 , Nosheen Pervaiz  2 , Salma Sharif  3 , Syed Naveed Ali Shah  4
Affiliations

Evaluating the Safety and Efficacy of Moderate-Intensity Statin Combined With Ezetimibe in Elderly Patients With Atherosclerotic Cardiovascular Disease

Muhammad Usman Khalid et al. Cureus. .

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent in the elderly and often requires intensive lipid-lowering therapy. However, high-intensity statins may lead to adverse effects such as myopathy, liver enzyme elevations, or cognitive changes in older adults. The objective of this study was to evaluate the safety and efficacy of moderate-intensity statin therapy in combination with ezetimibe for lipid control and cardiovascular risk reduction in elderly patients with established ASCVD.

Methods: This retrospective, observational cohort study was conducted at Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, from January 2023 to June 2023. A total of 221 elderly patients (age ≥60 years) with established ASCVD were included in the study. Results: The mean low-density lipoprotein cholesterol (LDL-C) level significantly decreased from 129.4 ± 18.7 mg/dL at baseline to 78.2 ± 16.4 mg/dL at six months (p < 0.001), representing a 39.6% reduction. LDL-C <70 mg/dL was achieved in 153 patients (69.2%), and <100 mg/dL in 202 patients (91.4%). Adverse events were infrequent: myalgia occurred in seven patients (3.2%), elevated liver enzymes in five patients (2.3%), and creatine kinase increase in four patients (1.8%), with no cases of rhabdomyolysis. Medication adherence was high, with 215 patients (97.3%) remaining on therapy, and only three patients (1.4%) discontinued treatment due to adverse effects. A total of 11 patients (5.0%) experienced major adverse cardiovascular events (MACE) during follow-up.

Conclusion: Combining moderate-intensity statins with ezetimibe is an effective and safe lipid-lowering strategy for elderly patients with ASCVD. The regimen achieved high rates of LDL-C goal attainment with minimal side effects and good adherence, making it a practical alternative to high-intensity statin monotherapy in this population.

Keywords: atherosclerotic cardiovascular disease; efficacy; ezetimibe; patients satisfaction; serum ldl cholesterol.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Health and Education Research Ethics and Governance Committee, Nottingham University Hospitals NHS Trust issued approval IRC/864/22. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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