Statins in elderly patients with acute coronary syndrome: an analysis of dose and class effects in typical practice
Statins in elderly patients with acute coronary syndrome: an analysis of dose and class effects in typical practice
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DOI：
10.1136/hrt.2006.110197
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发表时间：
2007-08-01
期刊：
影响因子：
5.7
通讯作者：
Winkelmayer, Wolfgang C.
中科院分区：
文献类型：
--
作者：
Choudhry, Niteesh K.;Levin, Raisa;Winkelmayer, Wolfgang C.
Objective: To compare the effectiveness of statins of different treatment intensity used to treat elderly patients with acute coronary syndrome (ACS) in typical care settings.Design: Retrospective cohort study using linked hospital and pharmacy claims data.Setting: Statewide pharmacy benefits programmes in Pennsylvania and New Jersey.Participants: 18 311 Medicare patients discharged alive after ACS who received a prescription for a statin within 90 days of hospital discharge.Main outcome measures: Using multivariable and propensity-matched Cox proportional hazards regression models, patients who were prescribed high- intensity and moderate-intensity statins were compared based on the drug - dose combination that they initially received. Individual drug - dose combinations were also compared. Our primary outcome was the composite of all-cause death or recurrent ACS.Results: Patients who received moderate-intensity statins were as likely to experience a primary outcome as patients treated with high-intensity statins (adjusted HR 1.02, 95% CI 0.96 to 1.08). Propensity matching did not change the results. Individually, all moderate- intensity statins were as effective as high-intensity atorvastatin with the exception of lovastatin (adjusted HR 1.22, 95% CI 1.09 to 1.36). Similarly, all high-intensity statins seem as effective as high-intensity atorvastatin but the CIs surrounding these estimates were wide.Conclusions: This analysis of elderly patients with ACS treated in typical care settings does not demonstrate the superiority of high-intensity over moderate-intensity statin treatment or significant differences among individual statins.
