Abstract
Background
The 2013 American College of Cardiology/American Heart Association cholesterol guideline
recommends high-intensity statin (HIS) in patients with atherosclerotic cardiovascular
disease, but little is known about the efficacy and safety of HIS in Asian ethnicity.
We assessed the effects of HIS in Taiwanese with acute myocardial infarction (AMI).
Methods
Consecutive patients admitted for new AMI between January 2010 and December 2013 without
prior statin use were enrolled from the Taiwan National Health Insurance Research
Database. Patients were grouped based on the intensity of statin they took after discharge.
The primary endpoint was the composite outcome of all-cause mortality, recurrent myocardial
infarction, and stroke. We also compared the incidences of severe hepatitis and myopathy
that need admission between HIS and non-HIS groups. We used propensity score analysis
to match covariates between groups and Cox proportional hazards models with adjustment
to estimate the risks of clinical outcomes.
Results
After 1:4 propensity score match, there were 4402 patients in the HIS group and 17,608
patients in the non-HIS group. After follow-up for 3 years, 668 patients (15.2%) in
the HIS group and 2749 (15.6%) in the non-HIS group had the primary composite endpoint.
Cox proportional-hazards analyses showed that HIS did not further reduce composite
endpoint (adjusted hazard ratio, 0.975; 95% confidence interval, 0.896-1.062); however,
HIS patients had a lower risk of ischemic stroke at 3-year follow-up. Regarding safety,
HIS did not increase hospitalization rates for severe hepatitis and myopathy.
Conclusions
Patients with AMI in Taiwan with HIS had similar clinical outcomes to those with non-HIS.
Using HIS for the effective reduction of low-density lipoprotein cholesterol is safe
in Taiwan.
Résumé
Contexte
Dans leurs lignes directrices de 2013 sur la cholestérolémie, l’American College of
Cardiology et l’American Heart Association recommandent l’emploi d’une statine de
forte intensité chez les patients atteints d’athérosclérose. On en sait toutefois
peu sur l’efficacité et l’innocuité de ce type de statines chez les patients d’origine
asiatique. Nous avons évalué les effets des statines de forte intensité chez des patients
taïwanais ayant subi un infarctus aigu du myocarde (IAM).
Méthodologie
Des patients hospitalisés de façon consécutive pour un nouvel IAM de janvier 2010
à décembre 2013, n’ayant pas été traités antérieurement par les statines, ont été
inscrits à l’étude à partir de la base de données de recherche du régime national
d’assurance maladie de Taïwan. Les patients étaient regroupés en fonction de l’intensité
des statines qu’ils avaient prises après avoir reçu leur congé de l’hôpital. Le principal
paramètre d’évaluation était composé de la mortalité toutes causes confondues, des
infarctus du myocarde récurrents et des accidents vasculaires cérébraux (AVC). Nous
avons également comparé l’incidence d’hépatite et de myopathie graves nécessitant
l’hospitalisation entre les groupes de patients recevant une statine de forte intensité
et ne recevant pas ce type de statines. Nous avons procédé à une analyse par scores
de propension pour apparier les variables entre les groupes et un modèle de régression
à risque proportionnel de Cox avec ajustements pour estimer les risques associés aux
résultats cliniques.
Résultats
Après appariement selon le score de propension dans un rapport de 1:4, on comptait
4 402 patients dans le groupe de traitement par une statine de forte intensité et
17 608 patients dans le groupe de sujets sans un tel traitement. Après un suivi de
3 ans, 668 patients (15,2 %) du groupe de traitement par une statine de forte intensité
et 2 749 patients (15,6 %) ne recevant pas de statine de forte intensité avaient subi
un événement figurant parmi les composants du principal paramètre d’évaluation. Les
analyses selon le modèle de régression à risque proportionnel de Cox ont montré que
l’utilisation d’une statine de forte intensité ne réduisait pas davantage l’atteinte
du paramètre d’évaluation composite (rapport des risques instantanés corrigé : 0,975;
intervalle de confiance à 95 % : 0,896-1,062); toutefois, les patients traités par
une statine de forte intensité présentaient un risque moins élevé d’AVC ischémique
au moment du suivi après 3 ans. Pour ce qui a trait à l’innocuité, l’emploi d’une
statine de forte intensité n’a pas fait augmenter le taux d’hospitalisation pour cause
d’hépatite et de myopathie graves.
Conclusions
Les patients taïwanais ayant subi un IAM et traités par une statine de forte intensité
ont obtenu des résultats cliniques semblables à ceux qui ont été observés chez les
patients n’ayant pas reçu de statine de ce type. Le recours à une statine de forte
intensité pour réduire efficacement le taux de cholestérol LDL (lipoprotéines de faible
densité) est sûr chez les patients d’origine taïwanaise.
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Article info
Publication history
Published online: October 30, 2019
Accepted:
October 16,
2019
Received:
August 9,
2018
Footnotes
See page 891 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
