Abstract 16707: High versus Low-to-Moderate Intensity Statin Treatment and One-Year Clinical Outcomes Among Older Patients With Coronary Artery Disease
Introduction: Clinical trial evidence suggests that high-intensity statin therapy reduces adverse clinical events relative to lower intensity therapy in patients with existing coronary artery disease (CAD). However, few studies to date have examined this association in real-world CAD populations.
Methods: We linked detailed in-hospital data for 15309 patients aged 65 and older in the Get With the Guidelines-CAD (GWTG-CAD) registry between 2005 and 2009 to CMS claims records to obtain one-year post-discharge clinical outcomes. We defined high-intensity statin therapy as receipt of any of the following at hospital discharge: atorvastatin>=40 mg, rosuvastatin >=20 mg, or simvastatin 80 mg. All other statins were classified as low-to-moderate intensity. We used Cox proportional hazards regression to evaluate 1-year major adverse cardiovascular events (MACE) and mortality risk following discharge. Inverse propensity weighting (IPW) was used to adjust for baseline differences between treatment groups.
Results: Of 15309 patients who were prescribed statins at hospital discharge, 4383 (28.6%) received high-intensity statin therapy. Patients prescribed high-intensity statins were younger, more often male, and more likely to be diagnosed with acute MI, particularly STEMI, than those who received low-to-moderate intensity statins. Over one year, unadjusted rates of mortality were lower in the high-intensity compared with the lower intensity treatment group (14.4% vs. 16.2%; p=0.005). Unadjusted rates of one-year MACE were similar by statin intensity group (57.8% vs. 58.3%; p=0.79). Following IPW adjustment, rates of mortality and MACE were similar between treatment groups (p=0.90 and p=0.99).
Conclusions: In an older population of hospitalized CAD patients, receipt of high-intensity statin therapy at discharge was associated with lower unadjusted 1-year mortality after discharge. However, this benefit did not persist following risk adjustment.
Author Disclosures: E.C. O’Brien: Research Grant; Modest; Merck. J. Wu: None. P. Schulte: None. A. Christian: None. D.L. Bhatt: Research Grant; Significant; Roche, Bristol Myers Squibb, Amarin, The Medicines Company, Astra Zeneca, Sanofi Aventis, Eisai, Ethicon, Medtronic. W.K. Laskey: None. A.F. Hernandez: Research Grant; Modest; Janssen, Novartis, Portola, BMS, Merck. Consultant/Advisory Board; Modest; BMS, Gilead, Boston Scientific, Janssen, Novartis. G.C. Fonarow: Research Grant; Modest; NHLBI, Merck. Consultant/Advisory Board; Modest; Medtronic; Novartis; Pfizer.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.