title: Investigating the prevalence, predictors, and prognosis of suboptimal statin use early after a non-ST elevation acute coronary syndrome.
abstract: High-potency statin therapy is recommended in the secondary prevention of cardiovascular disease but discontinuation, dose reduction, statin switching, and/or nonadherence occur in practice.
  
  
  
  To determine the prevalence and predictors of deviation from high-potency statin use early after a non-ST elevation acute coronary syndrome (NSTE-ACS) and its association with subsequent major adverse cardiovascular events (MACE) and all-cause mortality (ACM).
  
  
  
  A total of 1005 patients from a UK-based prospective NSTE-ACS cohort study discharged on high-potency statin therapy (atorvastatin 80 mg, rosuvastatin 20 mg, or 40 mg daily) were included. At 1 month, patients were divided into constant high-potency statin users, and suboptimal users incorporating statin discontinuation, dose reduction, switching statin to a lower equivalent potency, and/or statin nonadherence. Follow-up was a median of 16 months.
  
  
  
  There were 156 suboptimal (∼15.5%) and 849 constant statin users. Factors associated in multivariable analysis with suboptimal statin occurrence included female sex (odds ratio 1.75, 95% confidence interval [CI] 1.14-2.68) and muscular symptoms (odds ratio 4.28, 95% CI 1.30-14.08). Suboptimal statin use was associated with increased adjusted risks of time to MACE (hazard ratio 2.10, 95% CI 1.25-3.53, P = .005) and ACM (hazard ratio 2.46, 95% CI 1.38-4.39, P = .003). Subgroup analysis confirmed that the increased MACE/ACM risks were principally attributable to statin discontinuation or nonadherence.
  
  
  
  Conversion to suboptimal statin use is common early after NSTE-ACS and is partly related to muscular symptoms. Statin discontinuation or non-adherence carries an adverse prognosis. Interventions that preserve and enhance statin utilization could improve post NSTE-ACS outcomes.
authors.affiliation: Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK. Electronic address: richard.turner@liverpool.ac.uk.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Turner
authors.affiliation: Department of Biostatistics, University of Liverpool, Liverpool, Merseyside, UK.
authors.forename: Peng
authors.initials: P
authors.lastname: Yin
authors.affiliation: Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Hanson
authors.affiliation: Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: FitzGerald
authors.affiliation: Department of Biostatistics, University of Liverpool, Liverpool, Merseyside, UK.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Morris
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, Merseyside, UK.
authors.forename: Rod H
authors.initials: RH
authors.lastname: Stables
authors.affiliation: Department of Biostatistics, University of Liverpool, Liverpool, Merseyside, UK.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Jorgensen
authors.affiliation: Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK.
authors.forename: Munir
authors.initials: M
authors.lastname: Pirmohamed
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D015995:Prevalence; D011379:Prognosis; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular; Discontinuation; Mortality; Muscular symptoms; Nonadherence; Statin