Patterns and predictors of intensive statin therapy among patients with diabetes mellitus after acute myocardial infarction

Mouin S. Abdallah, Mikhail Kosiborod, Fengming Tang, Wassef Y. Karrowni, Thomas M. Maddox, Darren K McGuire, John A. Spertus, Suzanne V. Arnold

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Abstract

Intensive statin therapy is a central component of secondary prevention after acute myocardial infarction (AMI), particularly among high-risk patients, such as those with diabetes mellitus (DM). However, the frequency and predictors of intensive statin therapy use after AMI among patients with DM have not been described. We examined patterns of intensive statin therapy use (defined as a statin with expected low-density lipoprotein cholesterol lowering of >50%) at discharge among patients with AMI with known DM enrolled in a 24-site US registry. Predictors of intensive statin therapy use were evaluated using multivariable hierarchical Poisson regression models. Among 1,300 patients with DM after AMI, 22% were prescribed intensive statin therapy at hospital discharge. In multivariable models, ST-elevation AMI (risk ratio [RR] 1.48, 95% confidence interval [CI] 1.29 to 1.70), insurance for medications (RR 1.28, 95% CI 1.00 to 1.63), and higher low-density lipoprotein cholesterol levels (RR 1.05 per 1 mg/dl, 95% CI 1.02 to 1.07) were independent predictors of intensive statin therapy, whereas higher Global Registry of Acute Coronary Events scores were associated with lower rates of intensive statin therapy (RR 0.94 per 10 points, 95% CI 0.91 to 0.98). In conclusion, only 1 in 5 patients with DM was prescribed intensive statin therapy at discharge after an AMI. Predictors of intensive statin therapy use suggest important opportunities to improve quality of care in this patient population.

Original languageEnglish (US)
Pages (from-to)1267-1272
Number of pages6
JournalAmerican Journal of Cardiology
Volume113
Issue number8
DOIs
StatePublished - Apr 15 2014

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Diabetes Mellitus
Myocardial Infarction
Odds Ratio
Confidence Intervals
Therapeutics
LDL Cholesterol
Registries
Patient Discharge
Quality of Health Care
Secondary Prevention
Insurance
HDL Cholesterol

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Patterns and predictors of intensive statin therapy among patients with diabetes mellitus after acute myocardial infarction. / Abdallah, Mouin S.; Kosiborod, Mikhail; Tang, Fengming; Karrowni, Wassef Y.; Maddox, Thomas M.; McGuire, Darren K; Spertus, John A.; Arnold, Suzanne V.

In: American Journal of Cardiology, Vol. 113, No. 8, 15.04.2014, p. 1267-1272.

Research output: Contribution to journalArticle

Abdallah, Mouin S. ; Kosiborod, Mikhail ; Tang, Fengming ; Karrowni, Wassef Y. ; Maddox, Thomas M. ; McGuire, Darren K ; Spertus, John A. ; Arnold, Suzanne V. / Patterns and predictors of intensive statin therapy among patients with diabetes mellitus after acute myocardial infarction. In: American Journal of Cardiology. 2014 ; Vol. 113, No. 8. pp. 1267-1272.
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abstract = "Intensive statin therapy is a central component of secondary prevention after acute myocardial infarction (AMI), particularly among high-risk patients, such as those with diabetes mellitus (DM). However, the frequency and predictors of intensive statin therapy use after AMI among patients with DM have not been described. We examined patterns of intensive statin therapy use (defined as a statin with expected low-density lipoprotein cholesterol lowering of >50{\%}) at discharge among patients with AMI with known DM enrolled in a 24-site US registry. Predictors of intensive statin therapy use were evaluated using multivariable hierarchical Poisson regression models. Among 1,300 patients with DM after AMI, 22{\%} were prescribed intensive statin therapy at hospital discharge. In multivariable models, ST-elevation AMI (risk ratio [RR] 1.48, 95{\%} confidence interval [CI] 1.29 to 1.70), insurance for medications (RR 1.28, 95{\%} CI 1.00 to 1.63), and higher low-density lipoprotein cholesterol levels (RR 1.05 per 1 mg/dl, 95{\%} CI 1.02 to 1.07) were independent predictors of intensive statin therapy, whereas higher Global Registry of Acute Coronary Events scores were associated with lower rates of intensive statin therapy (RR 0.94 per 10 points, 95{\%} CI 0.91 to 0.98). In conclusion, only 1 in 5 patients with DM was prescribed intensive statin therapy at discharge after an AMI. Predictors of intensive statin therapy use suggest important opportunities to improve quality of care in this patient population.",
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