Frequency of Intensive Statin Therapy in Patients With Acute Coronary Syndrome Admitted to a Tertiary Care Center

Shiu, Jennifer; Pearson, Glen J.; Charrois, Theresa L.; Gyenes, Gábor; Koshman, Sheri L.

doi:10.1016/j.amjcard.2011.07.064

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Despite high rates of statin use, intensive statin regimens, which are recommended by many guidelines, were only used in just over half of patients with AMI in China in 2011. Similar gaps have also been observed in the US [ 24 ], France [ 25 ], and Canada [ 26 ], although the higher threshold for LDL-C lowering of 50% was used to defined intensive therapy in these countries. Potential barriers to the greater use of intensive statin regimens could include physicians’ concerns about dose-dependent adverse effects of statin [ 27 , 28 ], an especially pertinent consideration given the increased risk of adverse events among Chinese patients [ 14 ].…”

Section: Discussionsupporting

confidence: 67%

National Assessment of Statin Therapy in Patients Hospitalized with Acute Myocardial Infarction: Insight from China PEACE-Retrospective AMI Study, 2001, 2006, 2011

Zhang

et al. 2016

PLoS ONE

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BackgroundStatin therapy is among the most effective treatments to improve short- and long-term mortality after acute myocardial infarction. The use of statin, and the intensity of their use, has not been described in acute myocardial infarction patients in China, a country with a rapidly growing burden of cardiovascular disease.Methods and ResultsUsing a nationally representative sample of patients with acute myocardial infarction admitted to 162 Chinese hospitals in 2001, 2006 and 2011, we identified 14,958 patients eligible for statin therapy to determine rates of statin use and the intensity of statin therapy, defined as those statin regimens with expected low-density lipoprotein cholesterol lowering of at least 40%, to identify factors associated with the use of statin therapy. Statin use among hospitalized patients with acute myocardial infarction increased from 27.9% in 2001 to 72.5% in 2006, and 88.8% in 2011 (P<0.001 for trend). Regional variation in statin use correspondingly decreased over time. Among treated patients, those receiving intensive statin therapy increased from 1.0% in 2001 to 24.2% in 2006 to 57.2% in 2011(P<0.001 for trend). Patients without low-density lipoprotein cholesterol measured were less likely to be treated with statin or to receive intensive therapy.ConclusionsThe use of statin therapy has dramatically increased over the past decade in Chinese patients with acute myocardial infarction. However, half of patients still did not receive intensive statin therapy in 2011.Given that guidelines strongly endorse intensive statin therapy for acute myocardial infarction patients, initiatives promoting the use of statin therapy, with attention to treatment intensity, would support further improvements in practice.

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Section: Discussionsupporting

confidence: 67%

National Assessment of Statin Therapy in Patients Hospitalized with Acute Myocardial Infarction: Insight from China PEACE-Retrospective AMI Study, 2001, 2006, 2011

Zhang

et al. 2016

PLoS ONE

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“…Such findings seem common to many regions of the world. 18,19,[34][35][36] Until recently, clinical guidelines tentatively recommended target LDL-C levels ≤70 mg/dL in those with established high-risk coronary disease. 11,37 This goal may, however, be confusing for practitioners when managing patients with ACS.…”

Section: Discussionmentioning

confidence: 99%

Antiatherosclerotic Effects of Long-Term Maximally Intensive Statin Therapy After Acute Coronary Syndrome

Puri

Nissen

Shao

et al. 2014

ATVB

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Objectives— Patients with acute coronary syndromes (ACS) display diffuse coronary atheroma instability and heightened risk of early and late recurrent coronary events. We compared the long-term antiatherosclerotic efficacy of high-intensity statins in patients with ACS when compared with stable disease. Approach and Results— Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. The overall effect of high-intensity statins on the change in coronary percent atheroma volume and major adverse cardiovascular events (death/nonfatal myocardial infarction/coronary revascularization) were evaluated in this post hoc analysis. When compared with non-ACS patients (n=678), patients with ACS (n=361) were younger, actively smoking, and have had a previous myocardial infarction (all P <0.001). At baseline, patients with ACS exhibited lower high-density lipoprotein cholesterol (43.5±11 versus 45.8±11 mg/dL; P =0.002), a higher apolipoprotein B: apolipoprotein A-1 ratio (0.90±0.24 versus 0.83±0.24; P <0.001) and greater percent atheroma volume (37.3±8.5% versus 35.9±8.1%; P =0.01) when compared with non-ACS patients. Despite similar achieved levels of lipid and inflammatory markers after high-intensity statin therapy, patients with ACS demonstrated greater percent atheroma volume regression than non-ACS patients (−1.46±0.14 versus −0.89±0.13; P =0.003). After propensity-weighted multivariable adjustment, baseline percent atheroma volume ( P <0.001) and an ACS clinical presentation ( P =0.02) independently associated with plaque regression. The 24-month major adverse cardiovascular events–free survival was similar between patients with ACS and non-ACS (90.6 versus 92.9%; P =0.25). Conclusions— Long-term high-intensity statin therapy caused greater plaque regression and comparable major adverse cardiovascular events rates in ACS when compared with non-ACS patients. Despite a higher clinical risk profile, patients with ACS harbor a more modifiable disease substrate and seem to benefit the most from potent statin therapy.

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“…Particularly, statins were continuously prescribed in approximately 70% of patients (Table 1), which could be very helpful in preventing the progression of atherosclerosis. 19 Second, a follow-up CAG was performed in a relatively low number of patients (14.8%). Because silent ischemia often occurs and the vasodilators could mask the patient's ischemic symptoms, 1 a follow-up CAG with or without a VSA provocation test should be more strongly recommended in future studies if clinically indicated.…”

Section: Rate Of Pcimentioning

confidence: 99%

Rates of Coronary Intervention Due to De Novo Significant Atherosclerosis and Cardiac Death Are Very Low in Korean Patients With Vasospastic Angina

Shin

Baek

Seo

et al. 2012

Circ J

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Frequency of Intensive Statin Therapy in Patients With Acute Coronary Syndrome Admitted to a Tertiary Care Center

Cited by 6 publications

References 18 publications

National Assessment of Statin Therapy in Patients Hospitalized with Acute Myocardial Infarction: Insight from China PEACE-Retrospective AMI Study, 2001, 2006, 2011

National Assessment of Statin Therapy in Patients Hospitalized with Acute Myocardial Infarction: Insight from China PEACE-Retrospective AMI Study, 2001, 2006, 2011

Antiatherosclerotic Effects of Long-Term Maximally Intensive Statin Therapy After Acute Coronary Syndrome

Rates of Coronary Intervention Due to De Novo Significant Atherosclerosis and Cardiac Death Are Very Low in Korean Patients With Vasospastic Angina

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