title: Falling cholesterol trend at acute coronary syndrome presentation is strongly related to statin use for secondary prevention.
abstract: BACKGROUND
  Lifestyle changes are believed responsible for temporal trends of reduced population total cholesterol (TC), but it is uncertain whether this applies to patients with known coronary heart disease (CHD) often prescribed lipid lowering therapy (LLT). We studied temporal TC trends at presentation with acute coronary syndrome (ACS) to determine the contribution of LLT given for secondary prevention.
  
  
  METHODS
  TC and LLT were obtained in 5592 patients in annual surveys of ACS admissions in Australia between 1999 and 2013, and annual mean trends analysed by linear and segmented regression.
  
  
  RESULTS
  TC declined from 5.13±1.1 to 4.53±1.2mmol/L (p<0.001) and LLT (96% statin) use at presentation increased from 37.4% to 47.5% (p=0.005). TC decline was greater in those on LLT vs. those not on therapy, with LLT contributing to 57% of the TC decline. The decline in TC and increase in LLT use was non-linear and much steeper in those with, than without CHD history, and LLT contributed substantially more to the TC decline (79%, p<0.001 vs. 27%, p=0.06 respectively). The rapid decline in TC and increase in LLT, plateauing after 2005 in those with CHD history differed markedly from trends in recent population studies, while TC trend for those without CHD history was slower, linear and consistent with population trends.
  
  
  CONCLUSIONS
  Declining TC level at presentation for ACS was strongly associated with increasing LLT use in those with a history of CHD, indicating that increasing uptake of LLT for secondary prevention has impacted TC changes in the new millennium.
authors.affiliation: University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chan
authors.affiliation: University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia.
authors.forename: Bilyana
authors.initials: B
authors.lastname: Dabin
authors.affiliation: University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia; The George Institute of Global Health, University of Sydney, Sydney, Australia.
authors.forename: Karice
authors.initials: K
authors.lastname: Hyun
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, Australia.
authors.forename: Lis
authors.initials: L
authors.lastname: Neubeck
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, Australia.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Aliprandi-Costa
authors.affiliation: Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lefkovits
authors.affiliation: Waikato Clinical School, University of Auckland, Auckland, New Zealand.
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
authors.affiliation: Liverpool Hospital, Southwestern Sydney Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Juergens
authors.affiliation: Flinders University, Southern Adelaide Local Health Network, Department of Cardiovascular Medicine, Adelaide, Australia.
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.affiliation: University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.affiliation: University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia; Anzac Research Institute, University of Sydney, Concord Hospital, Sydney, Australia; Heart Research Institute, Charles Perkins Centre, University of Sydney, Australia. Electronic address: ben.freedman@sydney.edu.au.
authors.forename: S Ben
authors.initials: SB
authors.lastname: Freedman
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011446:Prospective Studies; D012042:Registries; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: Acute coronary syndrome; Cholesterol; Statin therapy; Temporal trend