Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes

Gaoqiang Xie, Yihong Sun, Phyo Kyaw Myint, Anushka Patel, Xingzi Yang, Min Li, Xian Li, Tao Wu, Shenshen Li, Runlin Gao, Yangfeng Wu

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Abstract

Background: The evidence of adherence to statin decreasing risk of major adverse cardiovascular events (MACEs) is still lack among patients discharged with acute coronary syndrome (ACS).Our objective is to determine the relationship between six-month adherence to statins and subsequent risk of MACEs in patients discharged with ACS.
Methods: Using two prospective registry cohorts (CPACS-1 and -2), we analyzed data from 12,516 consecutive patients with ACS who were prescribed statin at hospital discharge and survived beyond 6 months without recurrent myocardial infarction (MI) or stroke. Adherence to statin was defined as good (using statin at discharge and 6 months without declined dosage) and poor adherence groups (using statin at discharge but declining dosage or stopping at 6 months). We compared the hazard ratios of all-cause mortality and MACE in subsequent 6 months between groups, using Cox-regression models, adjusting for multiple potential confounders.
Results: Seventy two percent of patients adhered to statin therapy at 6 months. The incident MACE in the poor adherence group was significantly higher than in good adherence group (2.7% vs. 1.8%, p = 0.002). Compared with poor adherence group, the good adherence group showed a 27% lower relative risk of MACE during the 6 month follow up (fully-adjusted hazard ratio (HR) = 0.73; 95%CI: 0.56–0.97). The protective effects of good adherence were similar in groups with different statin dose as well as groups by other baseline clinical characteristics and treatments (p > 0.05 for interaction).
Conclusion: Our study highlights the importance of adherence to statin therapy in prevention of MACE and clinicians should aim to achieve higher dosage if tolerable.
Clinical trial registration: CPACS2 was registered on URL: http://www.anzctr.org.au/default.aspx and unique identifier is ACTRN12609000491268. CPACS1 was not a clinical trial and thus not registered.
Original languageEnglish
Article number155
Pages (from-to)1-8
Number of pages8
JournalLipids in Health & Disease
Volume16
DOIs
Publication statusPublished - 15 Aug 2017

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Acute Coronary Syndrome
Hazards
Clinical Trials
Proportional Hazards Models
Registries
Therapeutics
Stroke
Myocardial Infarction

Keywords

  • Adherence
  • Statin
  • Major advers e cardiovascular events (MACEs)
  • Acute coronary syndrome (ACS)
  • Cohort

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Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes. / Xie, Gaoqiang; Sun, Yihong; Myint, Phyo Kyaw; Patel, Anushka; Yang, Xingzi; Li, Min; Li, Xian; Wu, Tao; Li, Shenshen; Gao, Runlin; Wu, Yangfeng.

In: Lipids in Health & Disease, Vol. 16, 155, 15.08.2017, p. 1-8.

Research output: Contribution to journalArticle

Xie, Gaoqiang ; Sun, Yihong ; Myint, Phyo Kyaw ; Patel, Anushka ; Yang, Xingzi ; Li, Min ; Li, Xian ; Wu, Tao ; Li, Shenshen ; Gao, Runlin ; Wu, Yangfeng. / Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes. In: Lipids in Health & Disease. 2017 ; Vol. 16. pp. 1-8.
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keywords = "Adherence, Statin, Major advers e cardiovascular events (MACEs), Acute coronary syndrome (ACS), Cohort",
author = "Gaoqiang Xie and Yihong Sun and Myint, {Phyo Kyaw} and Anushka Patel and Xingzi Yang and Min Li and Xian Li and Tao Wu and Shenshen Li and Runlin Gao and Yangfeng Wu",
note = "Acknowledgements: The authors thank all participants who contributed to the study. Funding: CPACS-1 was funded by unrestricted educational grants from Guidant and Sanofi-Aventis, and grants from The Royal Australasian College of Physicians. AP is supported by an Australian National Heart Foundation Career Development Award. CPACS-2 was funded by an unrestricted grant from Sanofi-Aventis China. The George Institute for Global Health at Peking University Health Science Center sponsored the study and owns the data. Data analyses and reports were supported by Beijing Science and Technology Key Research Plan (D151100002215001). However, the authors are solely responsible for the design, analyses, the drafting and editing of the manuscript, and its final contents.",
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T1 - Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes

AU - Xie, Gaoqiang

AU - Sun, Yihong

AU - Myint, Phyo Kyaw

AU - Patel, Anushka

AU - Yang, Xingzi

AU - Li, Min

AU - Li, Xian

AU - Wu, Tao

AU - Li, Shenshen

AU - Gao, Runlin

AU - Wu, Yangfeng

N1 - Acknowledgements: The authors thank all participants who contributed to the study. Funding: CPACS-1 was funded by unrestricted educational grants from Guidant and Sanofi-Aventis, and grants from The Royal Australasian College of Physicians. AP is supported by an Australian National Heart Foundation Career Development Award. CPACS-2 was funded by an unrestricted grant from Sanofi-Aventis China. The George Institute for Global Health at Peking University Health Science Center sponsored the study and owns the data. Data analyses and reports were supported by Beijing Science and Technology Key Research Plan (D151100002215001). However, the authors are solely responsible for the design, analyses, the drafting and editing of the manuscript, and its final contents.

PY - 2017/8/15

Y1 - 2017/8/15

N2 - Background: The evidence of adherence to statin decreasing risk of major adverse cardiovascular events (MACEs) is still lack among patients discharged with acute coronary syndrome (ACS).Our objective is to determine the relationship between six-month adherence to statins and subsequent risk of MACEs in patients discharged with ACS.Methods: Using two prospective registry cohorts (CPACS-1 and -2), we analyzed data from 12,516 consecutive patients with ACS who were prescribed statin at hospital discharge and survived beyond 6 months without recurrent myocardial infarction (MI) or stroke. Adherence to statin was defined as good (using statin at discharge and 6 months without declined dosage) and poor adherence groups (using statin at discharge but declining dosage or stopping at 6 months). We compared the hazard ratios of all-cause mortality and MACE in subsequent 6 months between groups, using Cox-regression models, adjusting for multiple potential confounders.Results: Seventy two percent of patients adhered to statin therapy at 6 months. The incident MACE in the poor adherence group was significantly higher than in good adherence group (2.7% vs. 1.8%, p = 0.002). Compared with poor adherence group, the good adherence group showed a 27% lower relative risk of MACE during the 6 month follow up (fully-adjusted hazard ratio (HR) = 0.73; 95%CI: 0.56–0.97). The protective effects of good adherence were similar in groups with different statin dose as well as groups by other baseline clinical characteristics and treatments (p > 0.05 for interaction).Conclusion: Our study highlights the importance of adherence to statin therapy in prevention of MACE and clinicians should aim to achieve higher dosage if tolerable.Clinical trial registration: CPACS2 was registered on URL: http://www.anzctr.org.au/default.aspx and unique identifier is ACTRN12609000491268. CPACS1 was not a clinical trial and thus not registered.

AB - Background: The evidence of adherence to statin decreasing risk of major adverse cardiovascular events (MACEs) is still lack among patients discharged with acute coronary syndrome (ACS).Our objective is to determine the relationship between six-month adherence to statins and subsequent risk of MACEs in patients discharged with ACS.Methods: Using two prospective registry cohorts (CPACS-1 and -2), we analyzed data from 12,516 consecutive patients with ACS who were prescribed statin at hospital discharge and survived beyond 6 months without recurrent myocardial infarction (MI) or stroke. Adherence to statin was defined as good (using statin at discharge and 6 months without declined dosage) and poor adherence groups (using statin at discharge but declining dosage or stopping at 6 months). We compared the hazard ratios of all-cause mortality and MACE in subsequent 6 months between groups, using Cox-regression models, adjusting for multiple potential confounders.Results: Seventy two percent of patients adhered to statin therapy at 6 months. The incident MACE in the poor adherence group was significantly higher than in good adherence group (2.7% vs. 1.8%, p = 0.002). Compared with poor adherence group, the good adherence group showed a 27% lower relative risk of MACE during the 6 month follow up (fully-adjusted hazard ratio (HR) = 0.73; 95%CI: 0.56–0.97). The protective effects of good adherence were similar in groups with different statin dose as well as groups by other baseline clinical characteristics and treatments (p > 0.05 for interaction).Conclusion: Our study highlights the importance of adherence to statin therapy in prevention of MACE and clinicians should aim to achieve higher dosage if tolerable.Clinical trial registration: CPACS2 was registered on URL: http://www.anzctr.org.au/default.aspx and unique identifier is ACTRN12609000491268. CPACS1 was not a clinical trial and thus not registered.

KW - Adherence

KW - Statin

KW - Major advers e cardiovascular events (MACEs)

KW - Acute coronary syndrome (ACS)

KW - Cohort

U2 - 10.1186/s12944-017-0544-0

DO - 10.1186/s12944-017-0544-0

M3 - Article

VL - 16

SP - 1

EP - 8

JO - Lipids in Health & Disease

JF - Lipids in Health & Disease

SN - 1476-511X

M1 - 155

ER -