title: Predictors of Nonuse of a High-Potency Statin After an Acute Coronary Syndrome: Insights From the Stabilization of Plaques Using Darapladib-Thrombolysis in Myocardial Infarction 52 (SOLID-TIMI 52) Trial.
abstract: High-potency statins reduce cardiovascular events after acute coronary syndromes but remain underused in clinical practice. We examined predictors of nonuse of high-potency statins after acute coronary syndromes.
  
  
  
  The Stabilization of pLaques usIng Darapladib-Thrombolysis in Myocardial Infarction (SOLID-TIMI 52) trial enrolled patients after an acute coronary syndrome in 36 countries between 2009 and 2011. Statin use was strongly encouraged throughout the trial, and statin potency was at the discretion of the treating physician. A high-potency statin was defined as ≥40 mg atorvastatin, ≥20 mg rosuvastatin, or 80 mg simvastatin daily. Predictors of nonuse of high-potency statins were examined using logistic regression. Of the patients included (n=12 446), 11 850 (95.2%) were treated with a statin at baseline after acute coronary syndrome (median 14 days), but only 5212 (41.9%) were on a high-potency statin. Selected patient factors associated with nonuse of high-potency statins included age ≥75 years (odds ratio 1.39, 95% CI 1.24-1.56), female sex (odds ratio 1.11, 95% CI 1.02-1.22), renal dysfunction (odds ratio 1.17, 95% CI 1.03-1.32), and heart failure during hospital admission (odds ratio 1.43, 95% CI 1.27-1.62). At 3 months after baseline, only 49% of patients had low-density lipoprotein cholesterol <70 mg/dL. Among the 5490 patients (59%) who were not on a high-potency statin at 3 months, lower low-density lipoprotein cholesterol was a predictor of nonuse of a high-potency statin after a median of 2.3 years (odds ratio 1.15 for 10 mg/dL decrease, 95% CI 1.11-1.19).
  
  
  
  Despite the widespread use of statins after acute coronary syndromes, most patients are not treated with high-potency statins early and late after the event, including patients at the highest risk of recurrent cardiovascular events.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01000727.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Alon
authors.initials: A
authors.lastname: Eisen
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.affiliation: University of Cincinnati, OH.
authors.forename: Dylan L
authors.initials: DL
authors.lastname: Steen
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Goodrich
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: KyungAh
authors.initials: K
authors.lastname: Im
authors.affiliation: Milpark Hospital, Johannesburg, South Africa.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Dalby
authors.affiliation: University Hospital Brno, Brno, Czech Republic.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: GlaxoSmithKline, Philadelphia, PA.
authors.forename: Shruti
authors.initials: S
authors.lastname: Daga
authors.affiliation: GlaxoSmithKline, Philadelphia, PA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Lukas
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA modonoghue@partners.org.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: O'Donoghue
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy*; D000069059:Atorvastatin / Q000008:administration & dosage; D001547:Benzaldehydes / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D016017:Odds Ratio; D010091:Oximes / Q000627:therapeutic use; D064801:Phospholipase A2 Inhibitors / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000453:epidemiology; D000068718:Rosuvastatin Calcium / Q000008:administration & dosage; D055502:Secondary Prevention; D012737:Sex Factors; D019821:Simvastatin / Q000008:administration & dosage; D001713:Biphenyl Compounds; D004048:Diethylamines; D011744:Pyrimidinones; D013440:Sulfides
chemical_list: D000069059:Atorvastatin; D001547:Benzaldehydes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010091:Oximes; D064801:Phospholipase A2 Inhibitors; D000068718:Rosuvastatin Calcium; D019821:Simvastatin; C529040:darapladib; D001713:Biphenyl Compounds; D004048:Diethylamines; D011744:Pyrimidinones; D013440:Sulfides
keywords: acute coronary syndrome; guideline; secondary prevention; statin therapy