TY - JOUR
T1 - Use of intensive lipid-lowering therapy in patients hospitalized with acute coronary syndrome
T2 - An analysis of 65,396 hospitalizations from 344 hospitals participating in Get with the Guidelines (GWTG)
AU - Javed, Usman
AU - Deedwania, Prakash C.
AU - Bhatt, Deepak L.
AU - Cannon, Christopher P.
AU - Dai, David
AU - Hernandez, Adrian F.
AU - Peterson, Eric D.
AU - Fonarow, Gregg C.
N1 - Funding Information:
Dr Bhatt: research grants from Astra Zeneca, Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, Sanofi Aventis and the Medicines Company. Dr Deedwania: consultant/ advisory board of AstraZeneca and Pfizer. Dr Peterson: research funding from Bristol Myers Squibb, Sanofi Aventis partnership. Dr Cannon: research grants from Accumetrics, AstraZeneca, Bristol-Myers Squibb/Sanofi Partnership, Glaxo Smith Kline Intekrin Therapeutics, Novartis, Takeda, clinical advisor and equity in Auto- medics Medical Systems. Dr Hernandez: research grant from Johnson and Johnson, Merck, and honorarium from AstraZeneca and Medtronic. Dr Fonarow: consultant/ advisory board to Merck Schering Plough and honorarium from Abbott, AstraZeneca, Merck Schering Plough, and Pfizer. Other authors have no disclosures.
PY - 2011/2
Y1 - 2011/2
N2 - Objectives: The study aimed to analyze the use of intensive lipid-lowering therapy (I-LLT) at discharge in a broad population of patients hospitalized with acute coronary syndrome (ACS). Background: Early and intensive statin therapy in ACS has been shown to reduce cardiovascular morbidity and mortality. Utilization and predictors of I-LLT among hospitalized ACS patients are not known. Methods: The GWTG database was analyzed for ACS-related hospitalizations from 2005 to 2009. The use of I-LLT (defined as dose of statin or combination therapy likely to produce >50% reductions in low-density lipoprotein [LDL]) and less intensive lipid-lowering therapy (LI-LLT) at discharge was assessed. Baseline characteristics and temporal trends in LLT were compared in these 2 treatment groups. Results: Of 65,396 patients receiving LLT, only 25,036 (38.3%) were treated with an I-LLT regimen. Mean total cholesterol, LDL, and triglycerides were significantly higher in the I-LLT group. Even among those with LDL >130 mg/dL, 50% or less received I-LLT. Predictors of I-LLT at discharge included LLT before admission, hyperlipidemia, prior coronary artery disease, increasing body mass index, and in-hospital percutaneous coronary intervention. Although there was some temporal improvement in the rate of I-LLT from 2005 to 2007, a decline in use of I-LLT was noted in 2008 and 2009. This was attributed to a sharp reduction in use of ezetimibe in combination with statin, without corresponding increases in intensive statin monotherapy. Conclusions: In a large cohort of patients admitted with ACS, most of the eligible patients were not discharged on I-LLT. These data suggest the need for better implementation of guideline-recommended intensive statin therapy in patients with ACS.
AB - Objectives: The study aimed to analyze the use of intensive lipid-lowering therapy (I-LLT) at discharge in a broad population of patients hospitalized with acute coronary syndrome (ACS). Background: Early and intensive statin therapy in ACS has been shown to reduce cardiovascular morbidity and mortality. Utilization and predictors of I-LLT among hospitalized ACS patients are not known. Methods: The GWTG database was analyzed for ACS-related hospitalizations from 2005 to 2009. The use of I-LLT (defined as dose of statin or combination therapy likely to produce >50% reductions in low-density lipoprotein [LDL]) and less intensive lipid-lowering therapy (LI-LLT) at discharge was assessed. Baseline characteristics and temporal trends in LLT were compared in these 2 treatment groups. Results: Of 65,396 patients receiving LLT, only 25,036 (38.3%) were treated with an I-LLT regimen. Mean total cholesterol, LDL, and triglycerides were significantly higher in the I-LLT group. Even among those with LDL >130 mg/dL, 50% or less received I-LLT. Predictors of I-LLT at discharge included LLT before admission, hyperlipidemia, prior coronary artery disease, increasing body mass index, and in-hospital percutaneous coronary intervention. Although there was some temporal improvement in the rate of I-LLT from 2005 to 2007, a decline in use of I-LLT was noted in 2008 and 2009. This was attributed to a sharp reduction in use of ezetimibe in combination with statin, without corresponding increases in intensive statin monotherapy. Conclusions: In a large cohort of patients admitted with ACS, most of the eligible patients were not discharged on I-LLT. These data suggest the need for better implementation of guideline-recommended intensive statin therapy in patients with ACS.
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U2 - 10.1016/j.ahj.2010.12.014
DO - 10.1016/j.ahj.2010.12.014
M3 - Comment/debate
C2 - 21404720
AN - SCOPUS:79951480490
SN - 0002-8703
VL - 161
SP - 418-424.e3
JO - American heart journal
JF - American heart journal
IS - 2
ER -