Scimex: Higher Intensity of Statin Therapy Associated With Lower Risk of Death in Patients with Atherosclerotic Cardiovascular Disease. Among more than 500,000 patients with atherosclerotic cardiovascular disease, researchers found an inverse association between intensity of statin therapy and mortality, with patients who received high-intensity statins having the greatest reductions in risk of death, according to a study published online by JAMA Cardiology.
remains the cornerstone for the prevention of atherosclerotic
cardiovascular disease (ASCVD). Many large, randomized trials have shown
that the use of statins significantly reduces the likelihood of future
cardiovascular events and mortality in diverse populations.
Nevertheless, statin therapy in general, and high-intensity statin
therapy in particular, is underused in patients with established ASCVD.
The Veterans Affairs (VA) health care system has released dyslipidemia
guidelines that recommend moderate-intensity statins for most patients
with ASCVD, citing insufficient evidence for recommending high-intensity
statin therapy except in some subgroups of patients at high risk for
Paul A. Heidenreich, M.D., M.S., of Stanford University,
Stanford, Calif., and colleagues examined 1-year cardiovascular
mortality by intensity of statin therapy among patients age 21 to 84
years with ASCVD treated in the Veterans Affairs health care system.
Intensity of statin therapy was defined by the 2013 American College of
Cardiology/American Heart Association guidelines, and use was defined as
a filled prescription in the prior 6 months.
The study sample
included 509,766 eligible adults with ASCVD at study entry (average age,
69 years), including 30 percent receiving high-intensity statin therapy
(defined as atorvastatin, 40 to 80 mg, rosuvastatin, 20 to 40 mg,
simvastatin, 80 mg), 46 percent receiving moderate-intensity statin
therapy (atorvastatin, 10 to 20 mg, fluvastatin, 40 mg twice a day or 80
mg once a day [extended-release formulation], lovastatin, 40 mg,
pitavastatin, 2 to 4 mg, pravastatin, 40 to 80 mg, rosuvastatin, 5 to 10
mg, and simvastatin, 20 to 40 mg), 6.7 percent receiving low-intensity
statin therapy (fluvastatin, 20 to 40 mg, lovastatin, 20 mg,
simvastatin, 10 mg, pitavastatin, 1 mg, and pravastatin, 10 to 20 mg),
and 18 percent receiving no statins.
During an average follow-up
of 492 days, there was a graded association between intensity of statin
therapy and mortality, with 1-year mortality rates of 4 percent for
those receiving high-intensity statin therapy, 4.8 percent for those
receiving moderate-intensity statin therapy, 5.7 percent for those
receiving low-intensity statin therapy, and 6.6 percent for those
receiving no statin. The researchers also found that the maximal doses
of high-intensity statins (atorvastatin, 80 mg, and rosuvastatin, 40 mg)
conferred the greatest survival advantage compared with submaximal
doses of high-intensity statins. The benefits of high-intensity statins
were consistent for those older than 75 years compared with younger
“We evaluated the real-world practice of statin use by
intensity and its association with all-cause mortality in a national
sample of patients with ASCVD in the VA health system. We found an
inverse graded association between intensity of statin therapy and
mortality. These findings suggest there is a substantial opportunity for
improvement in the secondary prevention of ASCVD through optimization
of intensity of statin therapy,” the authors write.