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High-potency statins yielded better survival outcomes after MI
A high-potency statin regimen reduced mortality risk significantly more than simvastatin monotherapy or combination simvastatin/ezetimibe after acute MI in a recent retrospective, longitudinal study.
Researchers evaluated data on 9,597 patients collected from the United Kingdom General Practice Research Database. All patients had been diagnosed with their first acute MI from 2004 to 2008. The cohort was 57% male, with a mean age of 65 ± 13 years.
All patients began a statin regimen within 30 days of the event and were divided into three groups during the follow-up period according to treatment approach: those who remained on simvastatin alone (n=6,990); were switched to a high-potency statin, such as atorvastatin or rosuvastatin (Crestor, AstraZeneca; n=1,883); and those who received concomitant therapy with ezetimibe (Zetia, Merck) and any statin (n=724).
Among patients with evaluable lipid levels, total and LDL cholesterol decreased significantly from baseline in all three groups, but the decrease was significantly greater in the high-potency and concomitant ezetimibe groups compared with the statin monotherapy recipients.
During a mean follow-up of 3.2 years, 1,134 deaths occurred. The adjusted HR for mortality was 0.72 (95% CI, 0.59-0.88) in the high-potency statin group and 0.96 (95% CI, 0.64-1.43) among ezetimibe recipients on multivariate analysis, indicating a significant decrease in mortality risk for the high-potency statin recipients, but not the ezetimibe recipients.
Similar results were observed upon propensity score analysis (adjusted HR=0.67; 95% CI, 0.54-0.81 for the high-potency statin group; adjusted HR=0.93; 95% CI, 0.62-1.38 for the ezetimibe group). Both associations lost their statistical significance in a sensitivity analysis of 2,787 patients with complete cholesterol, BP and glomerular filtration rate data (HR=0.79; 95% CI, 0.55-1.131 for high-potency statins; HR=1.03; 95% CI, 0.47-2.23 for ezetimibe).
“Our study found that, compared with those individuals who remained on simvastatin monotherapy, patients who switched to a high-potency statin … were associated with a lower mortality risk, even after adjustment for other potential prognostic factors, including age, renal function and concurrent use of CV drugs,” the researchers wrote. However, they also noted the small size of the group that received concomitant ezetimibe/statin therapy and acknowledged the possibility that the study was not sufficiently powered to determine treatment effect.
Disclosure: The researchers report no relevant financial disclosures.