Statins in elderly patients with acute coronary syndrome: an analysis of dose and class effects in typical practice.
OBJECTIVE
To compare the effectiveness of statins of different treatment intensity used to treat elderly patients with acute coronary syndrome (ACS) in typical care settings.


METHODS
Retrospective cohort study using linked hospital and pharmacy claims data.


METHODS
Statewide pharmacy benefits programmes in Pennsylvania and New Jersey.


METHODS
18,311 Medicare patients discharged alive after ACS who received a prescription for a statin within 90 days of hospital discharge.


METHODS
Using multivariable and propensity-matched Cox proportional hazards regression models, patients who were prescribed high-intensity and moderate-intensity statins were compared based on the drug-dose combination that they initially received. Individual drug-dose combinations were also compared. Our primary outcome was the composite of all-cause death or recurrent ACS.


RESULTS
Patients who received moderate-intensity statins were as likely to experience a primary outcome as patients treated with high-intensity statins (adjusted HR 1.02, 95% CI 0.96 to 1.08). Propensity matching did not change the results. Individually, all moderate-intensity statins were as effective as high-intensity atorvastatin with the exception of lovastatin (adjusted HR 1.22, 95% CI 1.09 to 1.36). Similarly, all high-intensity statins seem as effective as high-intensity atorvastatin but the CIs surrounding these estimates were wide.


CONCLUSIONS
This analysis of elderly patients with ACS treated in typical care settings does not demonstrate the superiority of high-intensity over moderate-intensity statin treatment or significant differences among individual statins.
Choudhry
Niteesh K
NK
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. nchoudhry@partners.org
Levin
Raisa
R
Winkelmayer
Wolfgang C
WC
D000368:Aged; D000069059:Atorvastatin; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality; D004334:Drug Administration Schedule; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008148:Lovastatin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D017035:Pravastatin / Q000008:administration & dosage / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011758:Pyrroles / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D019821:Simvastatin / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D011758:Pyrroles; D008148:Lovastatin; D000069059:Atorvastatin; D019821:Simvastatin; D017035:Pravastatin