title: Impact of early statin initiation on secondary prevention in Japanese patients with coronary artery disease.
abstract: BACKGROUND
  The effect of early statin initiation on secondary prevention remains uncertain in unselected Japanese populations with coronary artery disease (CAD).
  
  
  METHODS
  We investigated the mortality and morbidity in CAD patients according to presence or absence of statins within 3 months after the diagnosis of CAD in the Shinken Database cohort study. The primary endpoint was all-cause mortality.
  
  
  RESULTS
  Data were available on 789 Japanese patients with CAD (male 78.8%). Among those, 351 patients (44.5%) received a statin. The mean (SD) baseline low-density lipoprotein (LDL)-cholesterol levels were 113.6 (35.7) mg/dL in the statin group and 113.6 (26.4) mg/dL in the non-statin group (p=0.992). Unadjusted 2-year survival in patients with or without statins was 98.4% and 92.1%, respectively (p<0.001). Among a prespecified subgroup of patients undergoing percutaneous coronary intervention (PCI) (n=238 with statins and n=183 without statins), a consistent effect of statins on 2-year survival was observed (98.5% and 90.9%, respectively, p<0.001). However, there was no significant difference in 2-year target lesion revascularization-free survival (77.9% in statins versus 73.7% in non-statins, respectively, p=0.298). The age- and gender-adjusted survival in the PCI subgroup was significantly higher in the statin group [hazard ratio (HR) 0.29, 95% confidence interval (CI) 0.095-0.913] compared to non-statin. Multivariate analysis showed statins significantly reduced mortality (HR 0.27, 95%CI 0.078-0.944), but not revascularization (HR 0.91, 95%CI 0.589-1.406).
  
  
  CONCLUSIONS
  This study suggested that statin therapy initiated early after the diagnosis of CAD can decrease the risk of fatal events in Japanese CAD patients.
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan. nmichi-kyu@umin.ac.jp
authors.forename: Michinari
authors.initials: M
authors.lastname: Nakamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Ken
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.forename: Akira
authors.initials: A
authors.lastname: Koike
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Funada
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
mesh_terms: D000368:Aged; D044466:Asian People; D003324:Coronary Artery Disease / Q000401:mortality* / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization; D055502:Secondary Prevention
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors