Risk of mortality and recurrent cardiovascular events in patients with acute coronary syndromes on high intensity statin treatment

Abstract

Several randomized controlled trials have shown a benefit of high-dose intensive statin treatment in reducing risk of death and second cardiovascular disease (CVD) events in patients previously diagnosed with an acute coronary syndrome (ACS). Non-randomized studies in clinical settings support these findings, but large, long-term, observational studies addressing CVD and non-CVD endpoints are lacking. In this retrospective longitudinal study, we followed ACS patients in Sweden during 2001–2012 using national health registry and medical record data. A total of 49,857 patients were identified, of whom 10,092 (20.2%) received high dose statins and 21,174 (42.7%) received no statins. Royston-Parmar parametric time-to-event models were implemented to model hazard for second CVD events and death, stratified by gender and diabetes diagnosis. We found that risk of a second CVD event developed similarly in both treatment groups, but was much higher in the no statin group. Risk of CVD-related death remained relatively constant for the high-statin group, while it increased over time for the no-statin group. Interestingly, males had higher mortality rates in the no-statin group, but not in the high-statin group. All-cause mortality and non-CVD-related death followed similar trends to those observed for CVD-related death. This work provides additional real-world evidence for effect of statins in CVD-related mortality. The hazard functions presented here can provide a basis for future survival modeling and health economic evaluation.

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

“…Although it was not significant, we also observed the negative trend (hypercholesterolaemia paradox). Our different prognostic results support the assumption of the presence of other modifiable risk factors, other than cholesterol levels, that deliberates this risk in the majority of patients and may explain why patients develop myocardial infarction despite a low LDL level 19,39 or why a considerable proportion of major adverse events are still not prevented by aggressive lipid‐lowering treatment 46 . We also observed during the long‐term follow‐up that non‐cardiac death was more prevalent, and an inverse association with plasma lipid levels was observed in concordance with previous reports 5,47,48 .…”

Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention

“…The relationship between the higher LDL cholesterol and a higher sense of normality may also be explained by risk compensation; people receiving a cholesterol medication might be more likely to engage in risky behaviours, such as consuming an unhealthy diet, as reported by Sugiyama, Tsugawa, Tseng, Kobayashi, and Shapiro (2014). This finding is noteworthy, because there is strong evidence that cholesterol medication has a beneficial effect on CHD patients' prognosis and is therefore a cornerstone of post-PCI patients' secondary preventative treatment (Rockberg, Jørgensen, Taylor, Sobocki, & Johansson, 2017).…”

Epidemiology of Pulmonary Fibrosis: A Cohort Study Using Healthcare Data in Sweden

“…Following a review of the literature, this is the first study linking the national registers with EMR data to describe the epidemiology of pulmonary fibrosis/IPF in the Swedish population. The method of combining data from EMRs and national registers has been used in numerous previous studies [17][18][19][20][21]. This allows patients to be followed between primary and secondary care settings, and to capture disease epidemiology and healthcare resource utilisation.…”