Prescription of statins at discharge and 1‐year risk of major clinical outcomes among acute coronary syndromes patients with extremely low LDL‐cholesterol in clinical pathways for acute coronary syndromes studies

Sun, Yihong; Xie, Gaoqiang; Patel, Anushka; Li, Shenshen; Zhao, Wei; Yang, Xu-Dong; Wu, Tao; Li, Min; Li, Xian; Du, Xin; Hu, Rong; Huo, Yong; Hu, Dayi; R, Gao; Wu, Yangfeng

doi:10.1002/clc.23040

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…Independent of its LDL-lowering effects, statin use may be associated with improved endothelial function, increased nitric oxide production, reduced proinflammatory cytokine expression, free radical production, vascular smooth muscle cell migration and proliferation 28. A reduction in MACE has been seen with low-intensity to moderate-intensity statin therapy even in patients with acute coronary syndrome with low baseline LDL levels (<1.8 mmol/L),29 suggesting that statins may be associated with benefits regardless of the LDL level achieved. These potential benefits may be particularly relevant in older populations, but need to be weighed against the increased adverse risk profile in older populations.…”

Section: Discussionmentioning

confidence: 99%

Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

Gnanenthiran

Cumming

et al. 2019

Heart

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ObjectiveLow levels of total cholesterol (TC) are associated with adverse outcomes in older populations. Whether this phenomenon is independent of statin use is unknown. We investigated the association between low TC levels and long-term major adverse cardiovascular events (MACE) in a prospective study of men aged ≥70 years without ischaemic heart disease (IHD) and whether this was influenced by statin use.MethodsThe CHAMP (Concord Health and Ageing in Men Project) cohort is a prospective cohort study of community-dwelling men aged ≥70 years. The relationship between TC and long-term MACE was analysed using Cox-regression modelling adjusted for comorbidities and stratified by statin use.ResultsThe study cohort comprised 1289 men (mean (±SD) age, 77.0±5.5 years; mean follow-up, 6.4±2.7 years). Decreasing TC level was associated with increased comorbidity burden, frailty and MACE (linear trend p<0.001). In men not on statin therapy (n=731), each 1 mmol/L decrease in TC was associated with increased MACE (HR 1.27, 95% CI 1.10 to 1.45, p=0.001) and mortality (HR 1.22, 95% CI 1.03 to 1.44, p=0.02) adjusted for comorbidities. In contrast, low TC in men on statins (n=558) was not associated with MACE (HR 0.91, 95% CI 0.74 to 1.11) or mortality (HR 0.86, 95% CI 0.68 to 1.09).ConclusionLow TC is associated with increased risk of MACE in older men without IHD who are not taking statin therapy but not in those on statins.

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Section: Discussionmentioning

confidence: 99%

Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

Gnanenthiran

Cumming

et al. 2019

Heart

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“…The details of the assessment are presented in Table 1. The eight cohort studies assessed by the NOS checklist, three studies had eight stars [42], [43], [44] and the remaining four studies had nine stars [45], [46], [47], [48], [49], representing high quality. The details of the assessment are shown in Table 2.…”

Section: Study Qualitymentioning

confidence: 99%

“…The lowest rate (24.7%) of statin utilization during the follow-up period was reported among elderly patients (≥65 years old) [31]. [43] 2013 * * * * * * * * 8 Gencer et al [49] 2015 * * * * * * * * * 9 Ferreira-González et al [44] 2016 * * * * * * * * 8 Mantel et al [45] 2017 * * * * * * * * * 9 Turner et al [46] 2017 * * * * * * * * * 9 Al-Zakwani et al [47] 2018 * * * * * * * * * 9 Sun et al [48] 2018 * * * * * * * * * 9…”

Section: Statin Utilizationmentioning

confidence: 99%

Statin Utilization among Patients with Acute Coronary Syndrome: Systematic Review

Dewi¹,

Thavorncharoensap²

2021

Open Access Maced J Med Sci

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BACKGROUND: The early use of statin with intensive regimen has been recommended by the recent guidelines as the prevention of acute coronary syndrome (ACS) related events among the high-risk patients. Meanwhile, the inconsistent statin utilization for targeted patient in current practice is still an issue. AIM: This study aims to review the utilization rate of statin among patients with ACS. METHODS: A systematic search of relevant studies published between inceptions to June 2020 was conducted in PubMed. Patients and intervention domains were used to build up the searching formula. A study was eligible for inclusion if it was an original study of patients with ACS and it examined the utilization of statin. The risk of bias was assessed using Axis and NOS checklist. RESULTS: Among the 49 eligible studies, 38 were cohort studies while the others were cross-sectional studies. The utilization rate of statin at hospital admission ranged from 16% to 61% while 25% to 75% during the hospitalization. Of the total studies, 35 studies reported the statin rate at discharge ranging from 58% to 99%. Almost all studies revealed the reduction of statin utilization rate along the follow-up period. The number of statins prescribed was found to be lower among female and elderly patients. CONCLUSION: Despite the established benefits of statin among patients with ACS, our study revealed that statin was underutilized for secondary prevention after ACS. To improve patients’ clinical outcomes with ACS, efforts should be made to increase optimal treatment and compliance with a statin.

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“…Statins therapy has been recommended as a core long-term secondary preventive treatment for patients with acute coronary syndrome (ACS) by several guidelines. [1][2][3][4][5] Despite strong evidence from basic and clinical studies [6][7][8] and recommendation by the guidelines, about 10%-30% of patients with ACS discontinued their statin treatment usually within 4 years with highest attrition in the first year in western countries. [9][10][11][12] It has been shown that discontinuation of statin therapy increases the risk of major adverse cardiovascular events (MACE) in patients with ACS after discharge in several countries including UK.…”

Section: Introductionmentioning

confidence: 99%

Associated factors for discontinuation of statin use one year after discharge in patients with acute coronary syndrome in China

et al. 2022

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ObjectivesTo determine the associated factors for discontinuation of statin use 1 year after discharge in patients who survived from acute coronary syndrome (ACS) in China.Settings75 hospitals across China.DesignA cohort follow-up study.ParticipantsThe study included 10 337 patients with ACS hospitalised in 2007–2010 and discharged with statins from 75 hospitals in China in the Clinical Pathways for Acute Coronary Syndromes in China Study-Phase 2 (CPACS-2), who were followed-up at 6 and 12 months postdischarge.Primary outcome measuresThe primary outcome was the discontinuation of statin use defined as not in current use of statin at either 6-month or 12-month follow-up.ResultsMultivariable logistic regression model showed that patients who did not have cholesterol measurement (adjusted OR=1.29; 95% CI: 1.10 to 1.50) and patients with either higher (1.27; 1.13 to 1.43) or lower dose of statin (1.22; 1.07 to 1.40), compared with those with standard dose, were more likely to discontinue the use of statin. In addition, patients on the CPACS-2 intervention pathway (adjusted OR=0.83; 95% CI: 0.74 to 0.94), patients with medical insurance (0.75; 0.67 to 0.85), history of hypertension (0.83; 0.75 to 0.92), high low-density lipoprotein cholesterol (0.70; 0.57 to 0.87) at the baseline, prior statin use (0.73; 0.63 to 0.84), use of atorvastatin (0.78; 0.70 to 0.88) and those who underwent percutaneous coronary intervention or coronary artery bypass grafting during hospitalisation (0.47; 0.43 to 0.53) were less likely to discontinue statin use. The 1-year statin discontinuation rate decreased from 29.5% in 2007–2008 to 17.8% in 2010 (adjusted OR=0.60; 95% CI: 0.51 to 0.70).ConclusionImplementing clinical pathway, enhancing medical insurance coverage, strengthening health education in both physicians and patients, using statin at standard dosage may help improve the adherence to statin use after discharge in Chinese patients with ACS.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12609000491268).

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Prescription of statins at discharge and 1‐year risk of major clinical outcomes among acute coronary syndromes patients with extremely low LDL‐cholesterol in clinical pathways for acute coronary syndromes studies

Abstract: Among ACS survivors with a very low baseline LDL-c, low to moderate intensity statin therapy was associated significantly with lower risk of MACEs and total mortality at 12 months. The results suggested that ACS survivors should take statin regardless of the baseline of LDL-c.

Cited by 5 publications

References 26 publications

Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

Statin Utilization among Patients with Acute Coronary Syndrome: Systematic Review

Associated factors for discontinuation of statin use one year after discharge in patients with acute coronary syndrome in China

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