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Titration to High-Intensity Statin Therapy Following Acute Myocardial Infarction in Patients With and Without

Gennaro Giustino1, Lisandro D Colantonio2, Todd M Brown3

  • 1Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Cardiovascular Drugs and Therapy
|August 6, 2018
PubMed

Insights

Patients with diabetes mellitus (DM) face higher cardiovascular disease (CVD) risks post-acute myocardial infarction (AMI). Most patients on low/moderate-intensity statins after AMI do not switch to high-intensity statins, regardless of DM status, leaving residual CVD risk.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Patients with diabetes mellitus (DM) have an elevated risk of cardiovascular disease (CVD) events, particularly after an acute myocardial infarction (AMI).
  • High-intensity statin therapy is proven to reduce CVD risk in patients post-AMI, including those with DM.

Purpose of the Study:

  • To determine the proportion of Medicare beneficiaries aged 66-75 who transitioned to high-intensity statins after an AMI hospitalization.
  • To compare statin titration rates between patients with and without DM.

Main Methods:

  • Retrospective analysis of Medicare beneficiaries (66-75 years) hospitalized for AMI between 2014-2015.
  • Examined statin prescription fills within 365 days prior to and 30 days after AMI hospitalization.
  • Compared titration to high-intensity statins (atorvastatin 40/80mg, rosuvastatin 20/40mg) between patients with and without DM.

Main Results:

  • Only 37.7% of patients with DM and 44.4% without DM initiated high-intensity statins post-AMI.
  • No significant difference in the risk ratio for titrating to high-intensity statins was observed between patients with and without DM (RR 1.01).
  • Among those initially on lower-intensity statins, a small percentage (7.5% with DM, 9.2% without DM) escalated to high-intensity statins within 182 days post-AMI.

Conclusions:

  • A majority of patients, irrespective of diabetes status, do not escalate to high-intensity statins after AMI when initially prescribed lower-intensity statins.
  • This failure to optimize statin therapy may leave a significant portion of patients, especially those with DM, at increased risk for recurrent CVD events.
Abstract

Keywords:
Diabetes mellitusMyocardial infarctionStatins

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