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Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes

BACKGROUND: The evidence of adherence to statin decreasing risk of major adverse cardiovascular events (MACEs) is still lack among patients discharged with acute coronary syndrome (ACS). Our objective is to determine the relationship between six-month adherence to statins and subsequent risk of MACE...

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Autores principales: Xie, Gaoqiang, Sun, Yihong, Myint, Phyo Kyaw, Patel, Anushka, Yang, Xingzi, Li, Min, Li, Xian, Wu, Tao, Li, Shenshen, Gao, Runlin, Wu, Yangfeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558746/
https://www.ncbi.nlm.nih.gov/pubmed/28810873
http://dx.doi.org/10.1186/s12944-017-0544-0
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author Xie, Gaoqiang
Sun, Yihong
Myint, Phyo Kyaw
Patel, Anushka
Yang, Xingzi
Li, Min
Li, Xian
Wu, Tao
Li, Shenshen
Gao, Runlin
Wu, Yangfeng
author_facet Xie, Gaoqiang
Sun, Yihong
Myint, Phyo Kyaw
Patel, Anushka
Yang, Xingzi
Li, Min
Li, Xian
Wu, Tao
Li, Shenshen
Gao, Runlin
Wu, Yangfeng
author_sort Xie, Gaoqiang
collection PubMed
description BACKGROUND: The evidence of adherence to statin decreasing risk of major adverse cardiovascular events (MACEs) is still lack among patients discharged with acute coronary syndrome (ACS). Our objective is to determine the relationship between six-month adherence to statins and subsequent risk of MACEs in patients discharged with ACS. METHODS: Using two prospective registry cohorts (CPACS-1 and -2), we analyzed data from 12,516 consecutive patients with ACS who were prescribed statin at hospital discharge and survived beyond 6 months without recurrent myocardial infarction (MI) or stroke. Adherence to statin was defined as good (using statin at discharge and 6 months without declined dosage) and poor adherence groups (using statin at discharge but declining dosage or stopping at 6 months). We compared the hazard ratios of all-cause mortality and MACE in subsequent 6 months between groups, using Cox-regression models, adjusting for multiple potential confounders. RESULTS: Seventy two percent of patients adhered to statin therapy at 6 months. The incident MACE in the poor adherence group was significantly higher than in good adherence group (2.7% vs. 1.8%, p = 0.002). Compared with poor adherence group, the good adherence group showed a 27% lower relative risk of MACE during the 6 month follow up (fully-adjusted hazard ratio (HR) = 0.73; 95%CI: 0.56–0.97). The protective effects of good adherence were similar in groups with different statin dose as well as groups by other baseline clinical characteristics and treatments (p > 0.05 for interaction). CONCLUSION: Our study highlights the importance of adherence to statin therapy in prevention of MACE and clinicians should aim to achieve higher dosage if tolerable. CLINICAL TRIAL REGISTRATION: CPACS2 was registered on URL: http://www.anzctr.org.au/default.aspx and unique identifier is ACTRN12609000491268. CPACS1 was not a clinical trial and thus not registered. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12944-017-0544-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-55587462017-08-18 Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes Xie, Gaoqiang Sun, Yihong Myint, Phyo Kyaw Patel, Anushka Yang, Xingzi Li, Min Li, Xian Wu, Tao Li, Shenshen Gao, Runlin Wu, Yangfeng Lipids Health Dis Research BACKGROUND: The evidence of adherence to statin decreasing risk of major adverse cardiovascular events (MACEs) is still lack among patients discharged with acute coronary syndrome (ACS). Our objective is to determine the relationship between six-month adherence to statins and subsequent risk of MACEs in patients discharged with ACS. METHODS: Using two prospective registry cohorts (CPACS-1 and -2), we analyzed data from 12,516 consecutive patients with ACS who were prescribed statin at hospital discharge and survived beyond 6 months without recurrent myocardial infarction (MI) or stroke. Adherence to statin was defined as good (using statin at discharge and 6 months without declined dosage) and poor adherence groups (using statin at discharge but declining dosage or stopping at 6 months). We compared the hazard ratios of all-cause mortality and MACE in subsequent 6 months between groups, using Cox-regression models, adjusting for multiple potential confounders. RESULTS: Seventy two percent of patients adhered to statin therapy at 6 months. The incident MACE in the poor adherence group was significantly higher than in good adherence group (2.7% vs. 1.8%, p = 0.002). Compared with poor adherence group, the good adherence group showed a 27% lower relative risk of MACE during the 6 month follow up (fully-adjusted hazard ratio (HR) = 0.73; 95%CI: 0.56–0.97). The protective effects of good adherence were similar in groups with different statin dose as well as groups by other baseline clinical characteristics and treatments (p > 0.05 for interaction). CONCLUSION: Our study highlights the importance of adherence to statin therapy in prevention of MACE and clinicians should aim to achieve higher dosage if tolerable. CLINICAL TRIAL REGISTRATION: CPACS2 was registered on URL: http://www.anzctr.org.au/default.aspx and unique identifier is ACTRN12609000491268. CPACS1 was not a clinical trial and thus not registered. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12944-017-0544-0) contains supplementary material, which is available to authorized users. BioMed Central 2017-08-15 /pmc/articles/PMC5558746/ /pubmed/28810873 http://dx.doi.org/10.1186/s12944-017-0544-0 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Xie, Gaoqiang
Sun, Yihong
Myint, Phyo Kyaw
Patel, Anushka
Yang, Xingzi
Li, Min
Li, Xian
Wu, Tao
Li, Shenshen
Gao, Runlin
Wu, Yangfeng
Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes
title Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes
title_full Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes
title_fullStr Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes
title_full_unstemmed Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes
title_short Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes
title_sort six-month adherence to statin use and subsequent risk of major adverse cardiovascular events (mace) in patients discharged with acute coronary syndromes
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558746/
https://www.ncbi.nlm.nih.gov/pubmed/28810873
http://dx.doi.org/10.1186/s12944-017-0544-0
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