title: Statin Treatment by Low-Density Lipoprotein Cholesterol Levels in Patients With Non-ST-Segment Elevation Myocardial Infarction/Unstable Angina Pectoris (from the CRUSADE Registry).
abstract: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with increased risk of myocardial infarction and is a target for disease prevention. The association between initial LDL-C and statin treatment in patients with non-ST-segment elevation myocardial infarction (NSTEMI)/unstable angina pectoris (UAP) has not been well characterized. We explored detailed LDL-C levels and statin treatment in 22,938 patients with NSTEMI/UAP enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines Registry (2003 to 2006). Patients reporting home statin use or previous cardiovascular disease were excluded. We examined statin receipt at discharge across 4 categories of baseline LDL-C: very low (<70 mg/dl), low (70 to 99 mg/dl), high (100 to 129 mg/dl), and very high (≥130 mg/dl). The largest proportion of patients had LDL-C ≥130 mg/dl (32.6%), followed by LDL-C 100 to 129 mg/dl (32.1%), LDL-C 70 to 99 mg/dl (24.9%), and LDL-C <70 mg/dl (10.4%). Compared with high LDL-C categories, patients in the lowest LDL-C category had their first NSTEMI/UAP event at a significantly older age and had higher rates of other cardiovascular risk factors (including hypertension and diabetes) but were less likely to have a family history of coronary artery disease. Overall, 80.3% of eligible patients with NSTEMI/UAP received statins at discharge, ranging from 63.8% in those with very low LDL-C (<70 mg/dl) to 88.1% in those with very high LDL-C (>130 mg/dl). In conclusion, >1/3 of patients with NSTEMI/UAP had an LDL-C level <100. Those with low LDL-C were older, had more co-morbidities, and were less likely to be prescribed a statin at discharge than those with higher LDL-C.
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina. Electronic address: emily.obrien@duke.edu.
authors.forename: Emily C
authors.initials: EC
authors.lastname: O'Brien
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: DaJuanicia N
authors.initials: DN
authors.lastname: Simon
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000188:drug therapy*; D008078:Cholesterol, LDL / Q000097:blood*; D015897:Comorbidity; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy*; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors