title: Patterns and predictors of intensive statin therapy among patients with diabetes mellitus after acute myocardial infarction.
abstract: Intensive statin therapy is a central component of secondary prevention after acute myocardial infarction (AMI), particularly among high-risk patients, such as those with diabetes mellitus (DM). However, the frequency and predictors of intensive statin therapy use after AMI among patients with DM have not been described. We examined patterns of intensive statin therapy use (defined as a statin with expected low-density lipoprotein cholesterol lowering of >50%) at discharge among patients with AMI with known DM enrolled in a 24-site US registry. Predictors of intensive statin therapy use were evaluated using multivariable hierarchical Poisson regression models. Among 1,300 patients with DM after AMI, 22% were prescribed intensive statin therapy at hospital discharge. In multivariable models, ST-elevation AMI (risk ratio [RR] 1.48, 95% confidence interval [CI] 1.29 to 1.70), insurance for medications (RR 1.28, 95% CI 1.00 to 1.63), and higher low-density lipoprotein cholesterol levels (RR 1.05 per 1 mg/dl, 95% CI 1.02 to 1.07) were independent predictors of intensive statin therapy, whereas higher Global Registry of Acute Coronary Events scores were associated with lower rates of intensive statin therapy (RR 0.94 per 10 points, 95% CI 0.91 to 0.98). In conclusion, only 1 in 5 patients with DM was prescribed intensive statin therapy at discharge after an AMI. Predictors of intensive statin therapy use suggest important opportunities to improve quality of care in this patient population.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: abdallahm@umkc.edu.
authors.forename: Mouin S
authors.initials: MS
authors.lastname: Abdallah
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Wassef Y
authors.initials: WY
authors.lastname: Karrowni
authors.affiliation: Division of Cardiology, VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, Colorado.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D009664:Norway / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors