High-intensity statin therapy yields better outcomes in acute coronary syndrome patients: a meta-analysis involving 26,497 patients

Yu, Shanshan; Jin, Jun; Chen, Zhongxiu; Luo, Xiaolu

doi:10.1186/s12944-020-01369-6

Cited by 20 publications

(15 citation statements)

References 46 publications

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“…The findings are also in line with recent studies in the cardiovascular literature, which support the early benefit of statins in cardiovascular disease. 24,25 Our findings support additional benefits of statins beyond the plaque stabilizing function and further support the use of statins regardless of LDL level. 26 Exploring the reasons for no statin use and deintensification is the next step in understanding whether and why these prescribing practices may be harmful.…”

Section: Discussionsupporting

confidence: 74%

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Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack

Dearborn

Hu²,

Bravata

et al. 2021

Stroke

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Background and Purpose: Practice guidelines recommend that most patients receive moderate- or high-potency statins after ischemic stroke or transient ischemic attack (TIA) of atherosclerotic origin. We tested the association of different patterns of potency for prescribed statin therapy—assessed before admission and at hospital discharge for ischemic stroke or TIA—on mortality in a large, nationwide sample of US Veterans. Methods: The study population included patients with an ischemic stroke or TIA occurring during 2011 at any of the 134 Veterans Health Administration facilities. We used electronic outpatient pharmacy files to identify statin dose at hospital admission and within 7 days after hospital discharge. We categorized statin dosing as low, moderate, or high potency; moderate or high potency was considered at goal. We created 6 mutually exclusive groups to reflect patterns of statin potency from hospital admission to discharge: goal to goal, low to goal, goal to low or goal to none (deintensification), none to none, none to low, and low to low. We used logistic regression to compare 30-day and 1-year mortality across statin potency groups. Results: The population included 9380 predominately White (71.1%) men (96.3%) who were hospitalized for stroke or TIA. In this sample, 34.1% of patients (n=3194) were discharged off a statin medication. Deintensification occurred in 14.0% of patients (n=1312) and none to none in 20.5% (n=1924). Deintensification and none to none were associated with a higher odds of mortality as compared with goal to goal (adjusted odds ratio 1-year mortality: deintensification versus goal to goal, 1.26 [95% CI, 1.02–1.57]; none to none versus goal to goal, 1.59 [95% CI, 1.30–1.93]). Adjustments for differences in baseline characteristics using propensity weighted scores demonstrated similar results. Conclusions: Underutilization of statins, including no treatment or underdosing after stroke (deintensification), was observed in approximately one-third of veterans with ischemic stroke or TIA and was associated with higher mortality when compared with patients who were at goal for statin prescription dosing.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 71%

Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack

Dearborn

Hu²,

Bravata

et al. 2021

Stroke

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“…In a meta-analysis involving 26497 patients (including 16 randomized controlled trials), which assess high-intensity and standard statin regimens for efficacy and safety in patients with ACS, high-intensity statin therapy resulted in more clinical benefits regarding MACE compared with standard statin treatment in both Asian (RR = 0.77; 95%CI, 0.61-0.98; P = 0.03) and non-Asian (RR = 0.79; 95%CI, 0.71-0.89; P < 0.0001) patients. 37 The fact that a sufficient number of cases failed to reach the target LDL levels in the long term may be due to treatment non-compliance or treatment inadequacy after discharge, which can be shown as a reason for not detecting a statistical relationship with mortality.…”

Section: Discussion Discussionmentioning

confidence: 99%

Retrospective Evaluation of In-Hospital and Thirty-Month Mortality Parameters in Cases of Acute Coronary Syndrome

ALAN

KAYIKÇIOĞLU

ALAN

2022

DAHUDER Medical Journal

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Objectives: The aim of this study is to retrospectively assess, from the hospital records of patients, the clinical data of patients and the treatment strategies practiced on patients who were diagnosed as Acute Coronary Syndrome (ACS) and hospitalized and treated in the Hospital of Faculty of Medicine to research the effect of these data on occurrence of cardiovascular events and 30 months mortality. Methods: It is a retrospective screening study in which patients hospitalized with the diagnosis of ACS between June 2007 and December 2008 in the Hospital of Faculty of Medicine Cardiology Clinic are evaluated by using patient file information and electronic data recording system information, and by calling patients. In-hospital and long-term follow-up deaths were the endpoints of the study. Statistical analysis was performed using SPSS (Version 15.0). Results: 985 patients were included in the study who were diagnosed as ACS, hospitalized and treated in the hospital. The categorization of the patients subjected to the analysis (n:901) according to their diagnosis is as follows: 339 (38%) cases diagnosed as UAP, 206 (23%) cases diagnosed as NSTEMI, and 356 (39%) cases diagnosed as STEMI. 78,4 % of cases were male while 21,6 % were female. It was found that cases with hypertension, hyperlipidemia, obesity risk factor, and with a history of cardiovascular disease fall into the NSTEMI and UAP groups with a larger proportion. Among the groups, the UAP diagnosed cases have the largest and the STEMI diagnosed cases have the smallest ratio of using medicine groups such as beta blocker, calcium-canal blocker, ACE inhibitor, ARB, diuretic, statin, fibrate and nitrate before being hospitalized. In-hospital mortality was frequently encountered with a percentage of 7.6 % in STEMI cases, 2.4 % in NSTEMI cases, and 0.6 % in UAP cases. 30-months of follow-up data were obtained in all diagnosis groups for long-term mortality assessment. 70 (7.8 %) deaths were observed within the follow-up. According to diagnosis groups, death was observed in 22 (6.5 %) of UAP cases, 22 (10.7 %) of NSTEMI cases, and 26 (7.3 %) of STEMI cases. Correlation between long-term survival (30 months) and in-hospital statin usage and statin usage in discharge was not significant (p value respectively 0.1 and 0.16). Correlation between an approximate 30-months-survival and in-hospital ACE inhibitor/ARB inhibitor usage and ACE inhibitor/ARB inhibitor usage during discharge was significant (p = 0.007 and p = 0.004). It is also found that there was a significant correlation between survival in the same period of time and in-hospital beta blocker usage (p = 0.01). There was not a significant correlation between beta blocker usage during discharge and long-term survival (p = 0.779). Conclusion: Results of the unicentral retrospective scanning study which involves 901 ACS diagnosed patients prove to be similar to the ones obtained from GRACE and Euro Heart Survey prospective studies which were carried out in multi-central environment and among outnumbered patients.

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“…Atorvastatin 40-80 mg and rosuvastatin 20-40 mg are statin therapy with high-intensity effects [11]. Simvastatin 20 mg/day with moderate intensity effects may provide better benefits to ischemic stroke patients than high-intensity statins, including lower risk of major adverse cardiac events, lower recurrent ischemic and hemorrhagic stroke, as well as a lower risk of experiencing recurrent hospitalizations for cardiovascular disease [13,27,28].…”

Section: Simvastatin Dosagementioning

confidence: 99%

New-onset type 2 DM risk in dyslipidemia and stroke patients due to simvastatin use

Yunita¹,

Suryanti²,

Candradikusuma³

2021

J Adv Pharm Educ Res

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High-intensity statin therapy yields better outcomes in acute coronary syndrome patients: a meta-analysis involving 26,497 patients

Cited by 20 publications

References 46 publications

Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack

Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack

Retrospective Evaluation of In-Hospital and Thirty-Month Mortality Parameters in Cases of Acute Coronary Syndrome

New-onset type 2 DM risk in dyslipidemia and stroke patients due to simvastatin use

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