Statin Use and Recurrent, Terminal Major Adverse Cardiovascular Events

Following an atherosclerotic cardiovascular disease (ASCVD) event, statin use increases, but almost half of patients remain untreated, according to study results published in The American Journal of Cardiology.

Among patients with a recent acute ASCVD event, researchers sought to investigate the relationship between recurrent major adverse cardiovascular events (MACE) and statin treatment. To accomplish this, they conducted a retrospective cohort study of 4 health care systems in the Health Care Systems Research Network database. They included data from 8168 adult survivors of an index ASCVD hospitalization between September 2013 and September 2014. These patients were followed for 1 year, and 47.33% of them filled a statin prescription 90 days or less prior to the index ASCVD event.

Following the index event, 50.83% of patients filled a statin prescription. These patients were aged mean 72.3 years, 43.50% were women, 79.17% were White, 9.10% were Black, 1.93% were Hispanic, 15.53% were current smokers, 45.81% had type 2 diabetes, 84.20% had hyperlipidemia, and 87.28% had hypertension.

There were 49.17% patients who did not fill a statin prescription following the index event. These patients were aged mean 75.2 years, 45.82% were women, 76.1% were White, 10.11% were Black, 1.92% were Hispanic, 15.04% were current smokers, and the 2 cohorts had similar percentages of comorbidities.

Within the 1-year follow-up, in 686 patients there were 763 MACE, of which 41.30% ended in death. Those with postindex event statin treatment saw an adjusted 1-year MACE risk reduction of 18% (hazard ratio, 0.82; 95% CI, 0.70-0.95; P =.007). A 19% nonstatistically significant reduction of nonfatal MACE was experienced by the statin cohort, as well as a 65% reduction in risk of all-cause death.

Study limitations include the retrospective design, and that data was limited to insurance claims so if a prescription was filled without insurance there was no record. There was also immortal time bias, and the choice of study period preceded new lipid-lowering therapies.

Researchers concluded that while there was a fractional increase in statin use following an ASCVD event, nearly half of the patients remained untreated by statins. They wrote, “The primary benefit of statin use was protection against early death. Statin use had the greatest impact in the first 6 months after an ASCVD event; therefore, it is crucial for patients to quickly adhere to this therapy.”

Disclosure: This research was supported by Amgen Inc. Please see the original reference for a full list of disclosures.

Reference

Tecson KM, Kluger AY, Cassidy-Bushrow AE, et al. Usefulness of statins as secondary prevention against recurrent and terminal major adverse cardiovascular events. Am J Cardiol. Published online May 20, 2022. doi:10.1016/j.amjcard.2022.04.018

This article originally appeared on The Cardiology Advisor