Not enough statins?

heart made out of pills

Nearly half of people admitted for acute coronary syndrome do not receive intensive statin therapy within 12 months, mostly due to them not being prescribed, a study has found

Sydney researchers have looked at the prevalence of intensive lipid-lowering therapy during the 12 months after people hospitalised with acute coronary syndrome (ACS) are discharged from hospital.

People who have experienced an ACS in the past are at high risk of further events, they explain in an article published in the MJA on Monday.

Meanwhile reducing cholesterol levels in these patients is considered an important secondary preventive goal by clinicians.

Researchers extracted data from a large registry, using a final study population of 3441 patients who were alive at discharge and for whom information on lipid-lowering therapy at discharge and at 6-month follow-up (1431 patients) or 12-month follow-up (2010 patients) were available.

About half the total population (1876 of 3441, or 55%) of patients were receiving intensive lipid-lowering therapy 6 or 12 months after their hospitalisation with an ACS

Meanwhile 826 (24%) were receiving “some form” of lipid-lowering therapy other than intensive therapy.

Just over one-fifth (739 or 22%) were receiving no lipid-lowering therapy at the time of their most recent follow-up.

Intensive lipid-lowering therapy was defined as treatment with atorvastatin (≥ 40 mg/day), rosuvastatin (≥ 20 mg/day) or simvastatin (≥ 80 mg/day), with or without ezetimibe.

Lower intensity statin therapy with ezetimibe, or ezetimibe alone, were also included as options.

Predictors of not receiving intensive statin therapy included:

  • Not being prescribed this treatment prior to their hospital admission
  • Not being prescribed this treatment at hospital discharge
  • Being a woman
  • Not being referred for cardiac rehabilitation
  • Being medically managed in hospital
  • Undergoing coronary artery bypass grafting

While being female is associated with an increased risk of statin intolerance, the researchers point out that in the data this was not adequately compensated for by prescribing of statin-sparing agent ezetimibe.

The results show that more patients need to be prescribed intensive lipid-lowering therapy during the 12 months after an ACS, they said.

“Optimising oral lipid-lowering therapy for people who have had an ACS should help prevent recurrent coronary events among people at high risk.”

See the full article here

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