Bach RG, Cannon CP, Giugliano RP, et al. - Among patients 75 years or older with stabilized acute coronary syndrome (ACS), researchers determined the impact on results and risks of combination ezetimibe and simvastatin vs simvastatin monotherapy to lower lipid levels. In this secondary analysis of the randomized clinical Improved Reduction of Outcomes: Vytorin Efficacy International Trial, which enlisted 18,144 individuals (aged 75 years or older), treatment with simvastatin-ezetimibe led to lower rates of the primary endpoint in comparison with simvastatin-placebo for adults younger than 65 years and for adults aged 65 to 74 years (0.9% and 0.8%, respectively), with the greatest absolute risk reduction of 8.7% for adults aged 75 years or older. Amongst younger or older adults, the rate of adverse events did not increase with simvastatin-ezetimibe in contrast with the simvastatin-placebo. Therefore, adults hospitalized for ACS derived benefit from higher-intensity therapy to lower lipid levels with simvastatin-ezetimibe vs simvastatin monotherapy, with the largest absolute risk decline in adults aged 75 years or older. Among older patients, the addition of ezetimibe to simvastatin was not linked to any significant increase in safety issues. These outcomes may have implications for guidelines on reducing lipid levels in elderly people.