Real-World Effectiveness of High- Versus Moderate-Intensity Statin Therapy in Thai Patients With Acute Coronary Syndrome and Who Had Undergone Primary Percutaneous Coronary Intervention

Abstract

Although high-intensity statins are recommended for atherosclerotic cardiovascular disease, evidence has shown that Asians may need lower dose statins to achieve similar effect when compared to Caucasians. Moreover, awareness of adverse effects leads physicians to initiate moderate-intensity statins. Comparative of high versus moderate-intensive statins on LDL-C among patients who had undergone primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) are less established in Thailand. We conducted a retrospective cohort study to identify pattern of statins prescribing and explored the effectiveness on lipid profiles, including LDL-C goal achievement (<70 mg/dL) in STEMI patients underwent PPCI. A total of 983 patients with STEMI who had undergone PPCI were identified during 2005-2015. At 3-month follow-up, 31.9% patients were investigated for their lipid profile. There was 26.11% of patients who received high-intensity statins. When compared to baseline, we found more LDL-C reduction (38.22% ± 26.75% vs 22.36% ± 35.05%, P < .01) in the high-intensity group. Eighty-one patients achieved the target LDL-C, the high-intensity group were able to achieve the LDL-C goal than moderate-intensity group, but did not reach statistical significance (24.1% vs 30.5%, P = .26). This study confirmed that high-intensity statins have superior for LDL-C reduction and tend to achieve LDL-C goal more than moderate-intensity statins.

Comparison of clinical outcomes between ACE inhibitor and ARB in AMI patients with dyslipidemia after successful stent implantation

“…Dyslipidemia is a major predictor for cardiovascular clinical outcomes after AMI (22). Recently, many studies have focused on a high-dose statin therapy to reduce the risk of cardiovascular death, Re-MI, and coronary revascularization in AMI patients (24)(25)(26), but not on the important roles of ACEIs or ARBs (4-7). It has been reported that circulating LDL-cholesterol/apolipoprotein B particles may be involved in promoting the upregulation of AT1 receptor genes and this leads to the structural overexpression of vascular AT1 receptors for angiotensin II in cultured vascular smooth muscle cells, as well as in hypercholesterolemic rabbits (13,27).…”