PMID- 28391887 OWN - NLM STAT- MEDLINE DCOM- 20171023 LR - 20220408 IS - 1933-2874 (Print) IS - 1876-4789 (Linking) VI - 11 IP - 1 DP - 2017 Jan-Feb TI - Investigating the prevalence, predictors, and prognosis of suboptimal statin use early after a non-ST elevation acute coronary syndrome. PG - 204-214 LID - S1933-2874(16)30454-8 [pii] LID - 10.1016/j.jacl.2016.12.007 [doi] AB - BACKGROUND: 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. OBJECTIVES: 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). METHODS: 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. RESULTS: There were 156 suboptimal ( approximately 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. CONCLUSIONS: 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. CI - Copyright (c) 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved. FAU - Turner, Richard M AU - Turner RM AD - Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK. Electronic address: richard.turner@liverpool.ac.uk. FAU - Yin, Peng AU - Yin P AD - Department of Biostatistics, University of Liverpool, Liverpool, Merseyside, UK. FAU - Hanson, Anita AU - Hanson A AD - Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK. FAU - FitzGerald, Richard AU - FitzGerald R AD - Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK. FAU - Morris, Andrew P AU - Morris AP AD - Department of Biostatistics, University of Liverpool, Liverpool, Merseyside, UK. FAU - Stables, Rod H AU - Stables RH AD - Liverpool Heart and Chest Hospital, Liverpool, Merseyside, UK. FAU - Jorgensen, Andrea L AU - Jorgensen AL AD - Department of Biostatistics, University of Liverpool, Liverpool, Merseyside, UK. FAU - Pirmohamed, Munir AU - Pirmohamed M AD - Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK. LA - eng GR - Department of Health/United Kingdom GR - WT098017/Wellcome Trust/United Kingdom PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20161228 PL - United States TA - J Clin Lipidol JT - Journal of clinical lipidology JID - 101300157 RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) SB - IM MH - Acute Coronary Syndrome/*diagnosis/*drug therapy/physiopathology MH - Aged MH - Dose-Response Relationship, Drug MH - *Electrocardiography MH - Female MH - Humans MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*pharmacology/therapeutic use MH - Male MH - Medication Adherence MH - Prevalence MH - Prognosis MH - Time Factors PMC - PMC5399750 OTO - NOTNLM OT - Cardiovascular OT - Discontinuation OT - Mortality OT - Muscular symptoms OT - Nonadherence OT - Statin EDAT- 2017/04/11 06:00 MHDA- 2017/10/24 06:00 PMCR- 2017/01/01 CRDT- 2017/04/11 06:00 PHST- 2016/06/17 00:00 [received] PHST- 2016/12/06 00:00 [revised] PHST- 2016/12/16 00:00 [accepted] PHST- 2017/04/11 06:00 [entrez] PHST- 2017/04/11 06:00 [pubmed] PHST- 2017/10/24 06:00 [medline] PHST- 2017/01/01 00:00 [pmc-release] AID - S1933-2874(16)30454-8 [pii] AID - 10.1016/j.jacl.2016.12.007 [doi] PST - ppublish SO - J Clin Lipidol. 2017 Jan-Feb;11(1):204-214. doi: 10.1016/j.jacl.2016.12.007. Epub 2016 Dec 28.