TY - JOUR
T1 - Statin use, intensity, and 3-year clinical outcomes among older patients with coronary artery disease
AU - O'brien, Emily C.
AU - Wu, Jingjing
AU - Schulte, Phillip J.
AU - Christian, Alexander
AU - Laskey, Warren
AU - Bhatt, Deepak L.
AU - Peterson, Eric D.
AU - Hernandez, Adrian F.
AU - Fonarow, Gregg C.
N1 - Funding Information:
The American Heart Association funded GWTG-CAD. The program has been supported in part by unrestricted educational grants to the American Heart Association by Pfizer, Inc (New York, NY), and the Merck-Schering Plough Partnership (North Wales, PA). This project was funded by the Merck Investigators Studies Program.
Funding Information:
AF Hernandez: Dr Hernandez reports receiving a research grant from Amgen, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Novartis, and Portola Pharmaceuticals and receiving honoraria from Amgen, GlaxoSmithKline, Janssen, and Novartis.
Funding Information:
E O’Brien: Dr O’Brien reports receiving research funding from Merck.
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background Clinical trial evidence suggests that statin therapy reduces adverse clinical events and provides even greater benefit at high-intensity doses in coronary artery disease (CAD) patients, yet few studies have examined this in clinical practice. Methods We linked detailed in-hospital data (2005-2009) on 15,729 Get With The Guidelines-CAD patients ≥65 years prescribed statins to Centers for Medicare and Medicaid Services claims. High-intensity statin therapy was defined as discharge prescription of atorvastatin ≥40 mg, rosuvastatin ≥20 mg, or simvastatin 80 mg. We used Kaplan-Meier curves to calculate all-cause mortality, major adverse cardiovascular events (MACEs), and all-cause readmission at 3 years postdischarge; log-rank tests to compare survival via overall statin use and intensity; and Cox proportional hazards regression with inverse propensity weighting to evaluate adjusted rates of adverse events over 3 years postdischarge. Results Of 35,903 patients meeting inclusion criteria, 24,367 (67.9%) were discharged on statin. Of 15,729 patients with statin intensity information, 4488 (28.5%) received high-intensity therapy; these recipients were more often younger, male, and had acute myocardial infarction. After inverse propensity weighting adjustment, statin use was associated with significantly lower hazards of mortality (hazard ratio 0.89, 95% CI 0.84-0.93) and MACE (0.92, 0.88-0.96), but not readmission (1.01, 0.97-1.04). High-intensity (vs low/moderate) use was not associated with lower risk of all-cause mortality (1.07, 1.00-1.14), MACE (1.05, 0.99-1.11), or readmission (1.05, 1.00-1.10). Clinically relevant subgroups had similar results. Conclusions In older hospitalized CAD patients, use of statin therapy at discharge was associated with improved long-term outcomes. Consistent with current American College of Cardiology/American Heart Association cholesterol guideline recommendations supporting moderate- rather than high-intensity statin therapy in CAD patients >75 years, high-intensity statin therapy was not associated with incremental benefit in this older population.
AB - Background Clinical trial evidence suggests that statin therapy reduces adverse clinical events and provides even greater benefit at high-intensity doses in coronary artery disease (CAD) patients, yet few studies have examined this in clinical practice. Methods We linked detailed in-hospital data (2005-2009) on 15,729 Get With The Guidelines-CAD patients ≥65 years prescribed statins to Centers for Medicare and Medicaid Services claims. High-intensity statin therapy was defined as discharge prescription of atorvastatin ≥40 mg, rosuvastatin ≥20 mg, or simvastatin 80 mg. We used Kaplan-Meier curves to calculate all-cause mortality, major adverse cardiovascular events (MACEs), and all-cause readmission at 3 years postdischarge; log-rank tests to compare survival via overall statin use and intensity; and Cox proportional hazards regression with inverse propensity weighting to evaluate adjusted rates of adverse events over 3 years postdischarge. Results Of 35,903 patients meeting inclusion criteria, 24,367 (67.9%) were discharged on statin. Of 15,729 patients with statin intensity information, 4488 (28.5%) received high-intensity therapy; these recipients were more often younger, male, and had acute myocardial infarction. After inverse propensity weighting adjustment, statin use was associated with significantly lower hazards of mortality (hazard ratio 0.89, 95% CI 0.84-0.93) and MACE (0.92, 0.88-0.96), but not readmission (1.01, 0.97-1.04). High-intensity (vs low/moderate) use was not associated with lower risk of all-cause mortality (1.07, 1.00-1.14), MACE (1.05, 0.99-1.11), or readmission (1.05, 1.00-1.10). Clinically relevant subgroups had similar results. Conclusions In older hospitalized CAD patients, use of statin therapy at discharge was associated with improved long-term outcomes. Consistent with current American College of Cardiology/American Heart Association cholesterol guideline recommendations supporting moderate- rather than high-intensity statin therapy in CAD patients >75 years, high-intensity statin therapy was not associated with incremental benefit in this older population.
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U2 - 10.1016/j.ahj.2015.11.014
DO - 10.1016/j.ahj.2015.11.014
M3 - Article
C2 - 26920593
AN - SCOPUS:84960462153
SN - 0002-8703
VL - 173
SP - 27
EP - 34
JO - American heart journal
JF - American heart journal
ER -