Reduced mortality rates after intensive statin therapy in managed-care patients.
OBJECTIVE
To evaluate whether intensive statin therapy in a managed-care setting produces greater clinical benefit than more moderate statin use.


METHODS
Adults hospitalized for a coronary heart disease (CHD) event were identified from a longitudinal database of pharmaceutical and medical claims. Propensity scores representing a patient's likelihood of receiving statin therapy were calculated. Statin-treated patients were those who received statin therapy within 30 days of hospital discharge after a CHD event, had been supplied with statin therapy for at least 10 days during the follow-up period, and received statin therapy for at least 10 days before the first recurrent CHD event. Standard or intensive statin therapy was identified according to low-density lipoprotein cholesterol reductions expected with statin dose. Patients in the standard and intensive groups were matched by propensity scores to patients not receiving statin therapy after discharge. Patients in the standard statin therapy group were also matched to patients who received intensive statin therapy. Mortality rates after hospital discharge were compared in all matched groups.


RESULTS
Patients treated with standard therapy experienced a 32% reduction in risk of death compared with patients not receiving statin therapy (P = 0.003). Patients who received intensive statin therapy after a CHD event experienced a 42% reduction in risk of mortality (P = 0.002) versus those not receiving statin therapy. Compared with standard therapy, intensive statin treatment further reduced the risk of death by 29% (P = 0.020).


CONCLUSIONS
High risk CHD patients benefit from intensive statin therapy in a real-world, managed-care cohort, confirming the results of randomized clinical trials.
Fintel
Dan
D
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. dfintel@northwestern.edu
Joyce
Amie
A
Mackell
Joan
J
Graff
Jennifer
J
Kuntze
Erik
E
Ollendorf
Daniel A
DA
D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D019992:Databases as Topic; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D007344:Insurance Claim Reporting; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors