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Canadian Journal of Cardiology

Efficacy and Safety of High-intensity Statins in Patients With Acute Myocardial Infarction: An Asian Perspective

  • Po-Sheng Chen
    Affiliations
    Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • Sheng-Hsiang Lin
    Affiliations
    Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • Cheng-Han Lee
    Affiliations
    Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • Hui-Wen Lin
    Affiliations
    Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • Yi-Heng Li
    Correspondence
    Corresponding author: Yi-Heng Li, MD, PhD, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 704, Taiwan. Tel.: +886-6-2353535, ext 2382; fax: +886-6-2753834.
    Affiliations
    Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Published:October 30, 2019DOI:https://doi.org/10.1016/j.cjca.2019.10.027

      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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