title: Risk of mortality and recurrent cardiovascular events in patients with acute coronary syndromes on high intensity statin treatment.
abstract: Several randomized controlled trials have shown a benefit of high-dose intensive statin treatment in reducing risk of death and second cardiovascular disease (CVD) events in patients previously diagnosed with an acute coronary syndrome (ACS). Non-randomized studies in clinical settings support these findings, but large, long-term, observational studies addressing CVD and non-CVD endpoints are lacking. In this retrospective longitudinal study, we followed ACS patients in Sweden during 2001-2012 using national health registry and medical record data. A total of 49,857 patients were identified, of whom 10,092 (20.2%) received high dose statins and 21,174 (42.7%) received no statins. Royston-Parmar parametric time-to-event models were implemented to model hazard for second CVD events and death, stratified by gender and diabetes diagnosis. We found that risk of a second CVD event developed similarly in both treatment groups, but was much higher in the no statin group. Risk of CVD-related death remained relatively constant for the high-statin group, while it increased over time for the no-statin group. Interestingly, males had higher mortality rates in the no-statin group, but not in the high-statin group. All-cause mortality and non-CVD-related death followed similar trends to those observed for CVD-related death. This work provides additional real-world evidence for effect of statins in CVD-related mortality. The hazard functions presented here can provide a basis for future survival modeling and health economic evaluation.
authors.affiliation: QuintilesIMS, Solna, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Rockberg
authors.affiliation: QuintilesIMS, Solna, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Jørgensen
authors.affiliation: Amgen Inc, Thousand Oaks, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Taylor
authors.affiliation: QuintilesIMS, Solna, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Sobocki
authors.affiliation: Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Johansson
keywords: ACS, Acute Coronary Syndrome; Acute coronary syndromes; CVD, Cardiovascular Disease; Cardiovascular disease; EMR, Electronic Medical Records; Epidemiology; HF, Heart Failure; ICD, International Classification of Diseases; IS, Ischemic Stroke; LDL, Low Density Lipoprotein; MI, Myocardial Infarction; Mortality; PCI, Percutaneous Coronary Intervention; RCT, Randomized Controlled Trial; STEMI, ST Elevation Myocardial Infarction; Secondary prevention