Abstract
Constituting hypolipidemic and pleiotropic effects, statins stabilize coronary artery plaque and may prevent STEMI events. This study investigated the association between contemporary statin pretreatment intensity, low-density lipoprotein cholesterol (LDL-C) levels, and the type of acute coronary syndrome (ACS) presentation: STEMI vs. NSTE-ACS. Data were drawn from the ACS Israeli Survey (ACSIS), a biennial prospective national survey that took place in 2008–2018. The rate of STEMI vs. NSTE-ACS was calculated by statin use, including statin intensity (high-intensity statin therapy (HIST) and low-intensity statin therapy (LIST) prior to the index ACS event. Among 5103 patients, 2839 (56%) were statin-naive, 1389 (27%) used LIST and 875 (17%) used HIST. Statin pretreated patients were older and had a higher rates of co-morbidities, cardiovascular disease history and pretreatment with evidence-based medications. STEMI vs. NSTE-ACS was lower among HIST vs. LIST vs. statin-naive patients (31.0%, 37.8%, and 54.0%, respectively, p for trend < 0.001). Multivariate analysis revealed that HIST was independently associated with lower STEMI presentation (ORadj 0.70; 95% CI 0.57–0.86), while LIST (ORadj 0.92; 95% CI 0.77–1.10) and LDL-C < 70 mg/dL (ORadj 0.96; 95% CI 0.82–1.14) were not. In conclusion, among patients admitted with ACS, pretreatment with HIST was independently associated with a lower probability of STEMI presentation, while LIST and LDL-C < 70 mg/dL were not.
Highlights
Statins form the cornerstone for the prevention of acute coronary syndrome (ACS), with well-established beneficial use in the last few decades [1]
Prior studies have demonstrated that the use of statins as primary or secondary prevention reduces ST-elevation myocardial infarction (STEMI) prevalence among patients presenting with ACS [6,7,8,9,10]
The current study evaluated the association between contemporary chronic statin treatment intensity (HIST vs. LIST) prior to the index ACS event, low-density lipoprotein cholesterol (LDL-C) level, and the type of ACS presentation (STEMI vs. NSTE-ACS) in a “real world” patient population, during 2008 to 2018
Summary
Statins form the cornerstone for the prevention of acute coronary syndrome (ACS), with well-established beneficial use in the last few decades [1] Both the 2018 American Heart Association/American College of Cardiology and the 2019 European Society of Cardiology (ESC) guidelines recommended that high-intensity statin therapy (HIST) should be the first-line treatment in all ACS patients, regardless of initial low-density lipoprotein cholesterol (LDL-C) values, and further treatment should be adjusted to reach predefined individualized LDL-C goals [2,3]. Prior studies have demonstrated that the use of statins as primary or secondary prevention reduces STEMI prevalence among patients presenting with ACS [6,7,8,9,10] These studies have not evaluated statin intensity nor the LDL-C level at presentation. We sought to evaluate the association between contemporary statin treatment intensity (HIST vs. low-intensity statin therapy (LIST) prior to the index ACS event, LDL-C levels, and type of ACS at presentation (STEMI vs. non-ST-elevation ACS (NSTE-ACS), including non-STEMI and unstable angina pectoris (UAP) in a “real world” patient population during the last decade
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
