In patients with atherosclerotic cardiovascular disease, study authors from Stanford University found that those who received high-intensity statins had the biggest reduction in mortality risk. Findings from the study are published in JAMA Cardiology.
Large randomized trials have shown statins to significantly decrease the odds of future cardiovascular events and mortality in various patient populations. However, statin therapy—especially high-intensity statin therapy—is underused in patients with atherosclerotic cardiovascular disease. Dyslipidemia guidelines issued by the Veterans Affairs (VA) health care system recommend moderate-intensity statins for most patients with atherosclerotic cardiovascular disease and mention there is evidence lacking to recommend high-intensity statin therapy except in some high-risk subgroups.
Study authors evaluated 1-year cardiovascular mortality according to statin intensity in patients aged 21-84 years with atherosclerotic cardiovascular disease treated in the VA health care system. Intensity of statin therapy was defined by the 2013 ACC/AHA guidelines; use was defined as a filled prescription within the past 6 months.
Of the total eligible adults (n=509,766), 30% were receiving high-intensity statin therapy (atorvastatin 40–80mg, rosuvastatin 20–40mg, or simvastatin 80mg). Moderate-intensity statin therapy (atorvastatin 10–20mg, fluvastatin 40mg twice daily or 80mg once daily [ER formulation], lovastatin 40mg, pitavastatin 2–4mg, pravastatin 40–80mg, rosuvastatin 5–10mg, simvastatin 20–40mg) was seen in 46% of patients and low-intensity statin therapy (fluvastatin 20–40mg, lovastatin 20mg, simvastatin 10mg, pitavastatin 1mg, pravastatin 10–20mg) was seen in 6.7% of patients. Eighteen percent of patients were not receiving any statin therapy.
A correlation was seen between statin intensity and mortality where 1-year mortality rates of 4% were observed in those receiving high-intensity statin therapy, 4.8% for moderate-intensity statin therapy, 5.7% for low-intensity statin therapy, and 6.6% for no statin therapy. Also, maximum doses of high-intensity statins (atorvastatin 80mg and rosuvastatin 40mg) translated to the best survival advantage vs. submaximal doses of high-intensity statins.
In addition, older adults aged >75 years demonstrated more consistent benefits of high-intensity statins than younger patients.
Study findings suggest “there is a substantial opportunity for improvement in the secondary prevention of atherosclerotic cardiovascular disease [ASCVD] through optimization of intensity of statin therapy,” stated study author Paul A. Heidenreich, MD, MS.
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