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Falling cholesterol trend at acute coronary syndrome presentation is strongly related to statin use for secondary

Thomas Chan1, Bilyana Dabin1, Karice Hyun2

  • 1University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia.

International Journal of Cardiology
|April 4, 2016
PubMed

Insights

Lipid lowering therapy (LLT) significantly reduced total cholesterol (TC) in patients with coronary heart disease (CHD) presenting with acute coronary syndrome (ACS). This indicates LLT

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Public Health

Background:

  • Lifestyle changes are thought to reduce population total cholesterol (TC).
  • The impact of these changes on patients with existing coronary heart disease (CHD) on lipid-lowering therapy (LLT) is unclear.
  • This study investigates temporal TC trends in acute coronary syndrome (ACS) patients to assess LLT's contribution to secondary prevention.

Purpose of the Study:

  • To determine temporal trends in total cholesterol (TC) at presentation with acute coronary syndrome (ACS).
  • To evaluate the contribution of lipid-lowering therapy (LLT) to these TC trends in patients with known coronary heart disease (CHD).
  • To assess the impact of LLT for secondary prevention on TC levels in ACS patients.

Main Methods:

  • Collected data on TC and LLT use in 5592 patients admitted with ACS between 1999 and 2013.
  • Analyzed annual mean trends using linear and segmented regression.
  • Compared TC trends and LLT contribution between patients with and without a history of CHD.

Main Results:

  • TC levels decreased significantly from 5.13±1.1 to 4.53±1.2 mmol/L (p<0.001).
  • LLT use (primarily statins) increased from 37.4% to 47.5% (p=0.005) at presentation.
  • LLT accounted for 57% of the TC decline, with a more substantial impact (79%) in patients with a history of CHD compared to those without (27%).

Conclusions:

  • Declining TC levels at ACS presentation are strongly linked to increased LLT use in patients with prior CHD.
  • The rise in LLT for secondary prevention has demonstrably impacted TC levels in the 21st century.
  • Trends in TC and LLT use for CHD patients differed significantly from general population trends.
Abstract

Keywords:
Acute coronary syndromeCholesterolStatin therapyTemporal trend

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