Low statin use in adults hospitalized with acute coronary syndrome
Kevin Selby1, David Nanchen1, Reto Auer1
1Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Insights
Few adults receive recommended statin therapy for primary prevention of cardiovascular disease (CVD) before experiencing a first acute coronary syndrome (ACS). This highlights a gap in guideline implementation for high-risk patients.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality.
- Primary prevention strategies, including statin use, are crucial for mitigating CVD risk.
- Clinical prediction scores help identify individuals who would benefit from preventive therapies.
Purpose of the Study:
- To evaluate the concordance between recommended and actual statin use for primary prevention of CVD.
- To assess statin utilization in adults prior to their first acute coronary syndrome (ACS) based on established risk stratification guidelines.
Main Methods:
- A cross-sectional study involving 3172 adults hospitalized with their first ACS without prior CVD.
- Risk stratification was performed using European Society of Cardiology (ESC) guidelines and clinical prediction scores.
- Pre-hospitalization statin use was compared against guideline-recommended eligibility.
Main Results:
- 37% of participants were classified as high-risk for cardiovascular mortality (≥5% 10-year risk) or had diabetes.
- Only 20% of high-risk individuals were on statins before hospitalization.
- Full implementation of ESC guidelines could have made an additional 27% of the total sample eligible for statins.
Conclusions:
- A significant gap exists between recommended and actual statin use for primary CVD prevention in high-risk individuals.
- The findings underscore suboptimal adherence to primary prevention guidelines among patients who subsequently experience ACS.
- Improved implementation of statin therapy in primary prevention could potentially reduce future cardiovascular events.
Objective:
To assess recommended and actual use of statins in primary prevention of cardiovascular disease (CVD) based on clinical prediction scores in adults who develop their first acute coronary syndrome (ACS).
Method:
Cross-sectional study of 3172 adults without previous CVD hospitalized with ACS at 4 university centers in Switzerland. The number of participants eligible for statins before hospitalization was estimated based on the European Society of Cardiology (ESC) guidelines and compared to the observed number of participants on statins at hospital entry.
Results:
Overall, 1171 (37%) participants were classified as high-risk (10-year risk of cardiovascular mortality ≥5% or diabetes); 1025 (32%) as intermediate risk (10-year risk <5% but ≥1%); and 976 (31%) as low risk (10-year risk <1%). Before hospitalization, 516 (16%) were on statins; among high-risk participants, only 236 of 1171 (20%) were on statins. If ESC primary prevention guidelines had been fully implemented, an additional 845 high-risk adults (27% of the whole sample) would have been eligible for statins before hospitalization.
Conclusion:
Although statins are recommended for primary prevention in high-risk adults, only one-fifth of them are on statins when hospitalized for a first ACS.
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