Abstract
There is conflicting evidence for the clinical benefit of statin therapy in patients with vasospastic angina (VSA). We investigated the association of statin therapy with clinical outcomes in relatively large populations with clinically suspected VSA from a nationwide population-based database. Data were collected from the Health Insurance Review and Assessment database records of 4,099 patients that were in an intensive care unit with VSA between January 1, 2008 and May 31, 2015. We divided the patients into a statin group (n = 1,795) and a non-statin group (n = 2,304). The primary outcome was a composite of cardiac arrest and acute myocardial infarction (AMI). The median follow-up duration was 3.8 years (interquartile range: 2.2 to 5.8 years). Cardiac arrest or AMI occurred in 120 patients (5.2%) in the statin group, and 97 patients (5.4%) in the non-statin group (P = 0.976). With inverse probability of treatment weighting, there was no significant difference in the rate of cardiac arrest or AMI between the two groups (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.76–1.30; P = 0.937), or even between the non-statin group and high-intensity statin group (adjusted HR, 1.08; 95% CI, 0.69–1.70; P = 0.75). The beneficial association of statin use with the primary outcome was consistently lacking across the various comorbidity types. Statin therapy was not associated with reduced cardiac arrest or AMI in patients with VSA, regardless of statin intensity. Prospective, randomized trials will be needed to confirm our findings.
Highlights
The precise mechanism of coronary artery spasm has not been fully established, several factors such as endothelial dysfunction, smooth muscle hyperreactivity, autonomic dysfunction, abnormal coronary microvascular function, and vascular inflammation can influence vasospasm [1,2,3,4,5,6]
Two recently published studies [8,9] showed no association of statin therapy with reduced cardiac death and recurrent myocardial infarction in vasospastic angina (VSA) without significant stenosis, even though statin therapy was associated with reductions in mortality and future atherosclerotic cardiovascular disease (ASCVD) risk in previous randomized trials with various ASCVD populations [10,11]
We investigated the association between statin therapy and clinical outcomes, and assessed whether clinical impacts of statin intensity are different in patients with VSA selected from a nationwide population-based database
Summary
The precise mechanism of coronary artery spasm has not been fully established, several factors such as endothelial dysfunction, smooth muscle hyperreactivity, autonomic dysfunction, abnormal coronary microvascular function, and vascular inflammation can influence vasospasm [1,2,3,4,5,6]. Two recently published studies [8,9] showed no association of statin therapy with reduced cardiac death and recurrent myocardial infarction in VSA without significant stenosis, even though statin therapy was associated with reductions in mortality and future ASCVD risk in previous randomized trials with various ASCVD populations [10,11]. These studies of VSA had two major limitations: they had a limited population, and the association between high-intensity statin and clinical outcomes was not seen because most of the study patients were treated with low- to moderate-intensity statin. We investigated the association of statin therapy with clinical outcomes and whether the clinical impacts of non–high-dose statin and high-dose statin are different, in relatively large populations with VSA from a nationwide population-based database
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