title: Comparison of utilization of statin therapy at hospital discharge and six-month outcomes in patients with an acute coronary syndrome and serum low-density lipoprotein>or=100 mg/dl versus<100 mg/dl.
abstract: The use of, factors associated with, and long-term outcomes related to statin therapy in patients with acute coronary syndromes and low-density lipoprotein (LDL) levels<100 mg/dl at the time of hospital presentation are unclear. This report describes the use of statins at hospital discharge in 8,492 patients with acute coronary syndromes enrolled in the Global Registry of Acute Coronary Events (GRACE; 1999 to 2005) according to baseline LDL levels (<100 vs>or=100 mg/dl) and compares 6-month outcomes in each group stratified by the use or nonuse of statin therapy. Seventy-two percent of patients with LDL levels>or=100 mg/dl, compared with 55% of patients with LDL levels<100 mg/dl, were discharged on statin therapy. Sociodemographic, clinical, and treatment variables varied between patients discharged on statins and those who were not. Patients receiving statins at discharge were twofold (LDL>or=100 mg/dl) to threefold (<100 mg/dl) more likely to be receiving statin therapy at 6 months compared with those not receiving statins at discharge. Statin use at discharge was associated with a significantly lower rate of 6-month cardiac complications in patients with LDL levels<100 mg/dl (adjusted odds ratio for the composite end point of myocardial infarction, stroke, and death 0.64, 95% confidence interval 0.47 to 0.88). In conclusion, data from this large observational study suggest that patients with acute coronary syndromes and LDL levels<100 mg/dl are much less likely to be prescribed statin therapy at hospital discharge or to be receiving statin therapy at 6 months but benefit from the prescription of statins at hospital discharge as much as patients with levels>or=100 mg/dl.
authors.affiliation: Department of Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada, and Coronary Care Unit, Concord Hospital, Sydney, Australia. fspence@mcmaster.ca
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Gordon
authors.initials: G
authors.lastname: FitzGerald
authors.forename: Jeanna
authors.initials: J
authors.lastname: Allegrone
authors.forename: David
authors.initials: D
authors.lastname: Brieger
mesh_terms: D000359:Aftercare; D000368:Aged; D000789:Angina, Unstable / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012042:Registries; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome