Initial prescription and persistence of intensive lipid-lowering therapy after acute coronary syndromes: insights from the NET-SCA prospective registry

Abstract

Intensive Lipid-Lowering Therapy (I-LLT) is recommended in patients admitted for Acute Coronary Syndromes (ACS). However, available studies suggest that most ACS patients do not receive such treatment, while limited information is currently available as to the prescription of I-LLT in Europe. The objective of our study was to assess the use of I-LLT in patients admitted for ACS along with the persistence of such treatment 90 days after discharge. According to previous studies, I-LLT was defined as statin or combination therapy likely to produce >50% reductions in low-density lipoprotein cholesterol and included atorvastation 40 or 80 mg, rosuvastatin 20 or 40 mg, simvastatin 80 mg, or any statin of any dose used in combination with ezetimibe. This study analyzed data the NET-SCA Registry.This Registry has been designed to document the clinical epidemiology, current management and outcome of ACS in the Lazio Region of Italy (ClinicalTrials.gov Identifier: [NCT01216462][1]). Lazio is a region of central Italy with a resident population of 5,600,000. The NET-SCA registry is an initiative of the Regional Section of the Italian Association of Hospital Cardiologists (ANMCO) and is currently collecting data about consecutive admissions for ACS in 12 hospitals. The study population included 3056 consecutive ACS patients (mean age 68±13 years, 30.8% women) with complete 90-day follow-up data. I-LLT was initiated during admission in 2068 patients (67.6%); atorvastatin 40-80 mg in 1524 (73.7%), rosuvastatin 20-40 mg in 511 (24.7%) and simvastatin 80 or combination of simvastatin and ezetimibe in the remaining 33 cases (1.6%). Independent predictors of I-LLT included statin therapy before admission, history of hyperlipidemia or prior ACS, and in-hospital percutaneous coronary intervention. Overall persistence of I-LLT 90 days after discharge was 76.1%, with 493 patients completely discontinuing such treatment or switching to lower non-intensive statin doses. Moreover, the 90-day persistence was significantly lower for atorvastatin 40-80 mg (73.6%), than for rosuvastatin 20-40 mg (82.2% - relative risk reduction of 0.32; 95% confidence interval 0.17-0.45, p<0.001). In this contemporary prospective registry more than two thirds of eligible ACS patients were on I-LLT during hospitalization. Besides, more than 75% of all ACS patients receiving I-LLT during admission were still on such treatment 90 days after discharge. Finally, I-LLT with rosuvastatin 20-40 mg was associated with a higher likelihood of persistence 90 days after discharge. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01216462&atom=%2Fehj%2F34%2Fsuppl_1%2F835.atom