PCV4 - Long-Term Efficacy Of Lower Intensity Statin Therapy In Chinese Acute Coronary Syndrome Patients

Abstract

Studies indicate that lower statin doses achieve lipid improvements in Asian patients comparable with higher doses in Caucasians. We aim to evaluate the correlation between lower statin doses and long-term clinical outcome. We analysed consecutive 2,553 patients (mean age 70.0 ± 13.4 years, 67.6% male) admitted with ACS between August 2010 and July 2014 to 3 hospitals in Hong Kong for a mean follow-up of 30 ± 17 months. There was no change in statin dosage or type. Statin therapy was divided into high (simvastatin (SIM) 80mg, atorvastatin (ATO) 40-80mg, rosuvastatin (ROS) 20-40mg); moderate (SIM 20-40mg, ATO 10-20mg, ROS 5-10mg) and low (SIM 10mg) intensity groups and compared. Outcome measures included achievement of LDL level <1.8mmol/L, all-cause mortality and major adverse cardiac events (MACE). Overall, 80.7% (n=2,059) of patients were discharged and remained on the same statin dose of which 6.2%, 62.6% and 31.2% were of high, moderate and low intensity, respectively. Simvastatin (mean dose 20.3mg) was used in 88.2% of cases. Patients with baseline LDL level ≥2.6mmol/L compared to LDL <1.8mmol/L were more likely to be prescribed moderate (68.7% vs. 50.6%) and high (7.4% vs. 4.9%) intensity statin (p<0.01). Achievement of LDL level <1.8mmol/L at follow-up was suboptimal in all groups (low intensity statin 38.1% vs. moderate 40.2% vs. high 50.0%, p=0.07). Neither LDL level at baseline nor follow-up were predictors of MACE at follow-up. Independent predictors of MACE included moderate statin intensity (odds ratio (OR) 0.60, 95%CI 0.44-0.84), STEMI (OR 0.64, 95%CI 0.48-0.86), percutaneous coronary intervention (OR 0.65, 95%CI 0.52-0.82), diabetes mellitus (OR 1.44, 1.15-1.82) and age≥65 years (OR 2.07, 1.59-2.71), all p<0.01. High intensity statin therapy was rarely prescribed in Chinese patients presenting with ACS irrespective of baseline LDL level. Moderate intensity statin therapy was an independent predictor of improved long-term clinical outcomes.