01 December 2011: Clinical Research
The impact of statin therapy on long-term cardiovascular outcomes in an outpatient cardiology practice
Hoang M. Lai ABCDEF , Wilbert S. Aronow ACDEF , Anthony D. Mercando ABCDEF , Phoenix Kalen C , Harit D. Desai BDF , Kaushang Gandhi BDF , Mala Sharma BDE , Harshad Amin BDF , Trung M. Lai C
DOI: 10.12659/MSM.882126
Med Sci Monit 2011; 17(12): CR683-686
Background
Numerous studies have demonstrated that statins reduce the incidence of coronary events in patients at high risk for coronary events [1–8]. The efficacy of statins in reducing coronary events in an outpatient cardiology practice needed to be investigated. This article reports data comparing the incidence of new myocardial infarction (MI), of new percutaneous coronary intervention (PCI), and of new coronary artery bypass graft surgery (CABGS) in 305 patients, mean age 74 years (93% with coronary artery disease), treated in an academic community cardiology practice during the time they were not treated with statins versus during the time they were subsequently treated with statins.
Material and Methods
Paper and electronics chart reviews were used to screen patients treated with statins at an academic community cardiology practice from 1978 to 2008. Based on the starting date of statin use, long-term clinical outcomes before and after statins start dates were calculated and compared. Patients who were treated with statins within the first year of follow-up were excluded from the study in order to achieve comparable duration of follow-up. Out of 1, 599 patients screened at the practice [9], 305 patients met all criteria and were included in the study.
For every patient, progress notes of all interim visits, letters of correspondence, medication use, blood pressure, laboratory studies including serum lipid levels, and occurrence of adverse cardiovascular events from the time of initial presentation to the last follow-up were recorded. Adverse events included occurrence of MI, need for PCI, and need for CABGS. Drug therapy and patient comorbidities including coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, cigarette smoking history, congestive heart failure, angina, atrial fibrillation, chronic kidney disease, peripheral arterial disease, abdominal aortic aneurysm, carotid artery stenosis, transient ischemic attack, stroke, and previous MI, PCI, and CABGS were recorded. Dates of the events as well as dates of medication initiation and discontinuation were recorded. Coronary artery disease was diagnosed as previously described [10–16].
Data were extracted by the physician authors and tabulated with Microsoft Access 2003 (Microsoft Corporation, Redmond, WA, USA). Customized computer programming was written for macros within Microsoft Excel 2003. The McNemar test was used to compare clinical outcomes. Adverse events occurring before the time of initial presentation were not included in the outcomes analysis. Stepwise logistic regression was performed with MEDCAL statistical software using 48 variables listed in Tables 1 and 2 to determine if use of statins was independently associated with MI, PCI, and CABGs. A p value of <0.05 was considered statistically significant.
Results
Table 1 shows the baseline characteristics of the 305 patients. Table 2 shows the prevalence of use of drugs in the 305 patients. Table 3 shows the incidence of MI, of PCI, and of CABGS before and after treatment with statins. Table 3 also shows levels of statistical significance.
Stepwise logistic regression analysis showed that use of statins was a significant independent predictor of new MI (odds ratio =0.0207; 95% CI, 0.0082–0.0522; p<0.0001), of new PCI (odds ratio =0.0109; 95% CI, 0.0038–0.0315; p<0.0001), and of new CABGS (odds ratio =0.0177; 95% CI, 0.0072–0.0431; p<0.0001).
Discussion
Numerous studies have demonstrated the importance of statins in the primary and secondary prevention of cardiovascular disease [1–8,17–36]. The present study compared the incidence of new MI, of new PCI, and of new CABGs in 305 patients, mean age 74 years (93% with coronary artery disease), treated in an academic community cardiology practice during the time they were not treated with statins versus during the time they were subsequently treated with statins.
At 65-month follow-up before treatment with statins and at 64-month follow-up after treatment with statins, the incidence of new MI was significantly reduced from 10% to 4% by statins (p<0.01), the incidence of new PCI was significantly reduced from 22% to 13% by statins (p<0.01), and the incidence of new CABGs was significantly reduced from 18% to 7% by statins (p<0.001). Stepwise logistic regression analysis using 48 variables showed that use of statins was a significant independent risk factor for reducing new MI, new PCI, and new CABGS (p <0.0001).
A limitation of this study is that it is a retrospective chart analysis study with all inherent problems of such a design.
Conclusions
Our data show that use of statins in patients with overt coronary artery disease (93%) or at high-risk for coronary artery disease in a community cardiology practice can reduce their chance of developing new MI, new PCI, and new CABGS. This study should give community practitioners, both specialists and primary care providers, the encouragement to pursue cardiovascular risk reduction strategies as a means for reducing new MI, PCI, and CABGS in their patients.
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