Abstract

Background: Elderly patients with primary hyperlipidemia have prolonged lipid metabolic disorder, chronic vascular endothelial damage, and significantly elevated risk of atherosclerotic cardiovascular disease (ASCVD). Statins are the first-line lipid-regulating drugs for elderly hyperlipidemia, but the clinical controversy regarding dose selection has persisted for many years. Intensive-dose statins can achieve stronger lipid-lowering and vascular protective effects, while they may bring higher risks of liver function damage, renal burden, myalgia and other adverse reactions in aging populations with declining organ reserve function. Low-dose statins have high safety but often fail to meet vascular endothelial repair and long-term cardiovascular protection needs. Methods: A retrospective controlled clinical study was designed. A total of 168 elderly patients (aged ≥65 years) diagnosed with primary hyperlipidemia were enrolled and equally divided into low-dose atorvastatin group (10 mg/d, n=84) and moderate-dose atorvastatin group (20 mg/d, n=84). All patients received standardized 12-week intervention and consistent lifestyle management. Baseline data, serum lipid profiles, vascular endothelial function biomarkers, hepatic and renal biochemical indexes, and adverse event incidence were statistically compared before and after treatment. Results: After 12 weeks of treatment, both groups obtained significant lipid improvement. The moderate-dose group showed significantly lower levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and significantly higher high-density lipoprotein cholesterol (HDL-C) than the low-dose group (P<0.05). In terms of vascular endothelial function, the moderate-dose group had higher nitric oxide (NO) and flow-mediated dilation (FMD), and lower endothelin-1 (ET-1), with statistically significant inter-group differences (P<0.05). There was no significant difference in the overall incidence of abnormal liver and renal function and mild adverse reactions between the two groups (P>0.05), and no severe adverse events occurred in either group. Conclusion: Moderate-dose atorvastatin achieves better lipid-lowering efficacy and vascular endothelial protective effects in elderly hyperlipidemic patients without significantly increasing organ safety risks. It is a safe and preferable routine clinical dosage for elderly patients with preserved basic organ function.

Keywords: elderly patients; hyperlipidemia; statins; dosage; vascular endothelial function; organ safety; clinical efficacy

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