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Clinical impact of statin therapy on vasospastic angina: data from a Korea nation-wide cohort study
Won-Woo Seo1, Sang-Ho Jo2, Sung Eun Kim1
1Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
Insights
Statin therapy did not significantly reduce adverse cardiovascular events in patients with vasospastic angina (VSA). This large prospective study found no benefit, regardless of statin intensity or spasm characteristics.
Area of Science:
- Cardiology
- Pharmacology
Background:
- The efficacy of statin therapy in preventing cardiovascular events in vasospastic angina (VSA) remains uncertain.
- Previous studies have yielded inconsistent results regarding statin use in VSA patients.
Purpose of the Study:
- To investigate the association between statin therapy and adverse cardiovascular events in a large, prospective cohort of VSA patients.
- To determine if statin use impacts the incidence of major adverse cardiovascular events in individuals diagnosed with VSA.
Main Methods:
- A prospective cohort of 1713 VSA patients diagnosed via coronary provocation test was analyzed.
- Patients were categorized into statin (n=744) and no-statin (n=914) groups based on discharge medication.
- The primary outcome was a composite of cardiac death, acute coronary syndrome, and life-threatening arrhythmia over a 3-year follow-up.
Main Results:
- The primary outcome occurred in 4.3% of the statin group and 3.1% of the no-statin group, with no significant difference.
- Kaplan-Meier analysis and propensity score matching showed no significant difference in cumulative outcomes between groups.
- Multivariate Cox regression identified focal VSA type as a predictor, but not statin therapy.
Conclusions:
- Statin therapy demonstrated no significant reduction in adverse cardiovascular events for patients with VSA.
- The findings were consistent across various statin intensities and spasm characteristics.
- Current evidence suggests statins may not be beneficial for preventing major adverse cardiovascular events in the VSA population.
Abstract:
The effect of statin therapy on reducing adverse cardiovascular events in vasospastic angina (VSA) has been inconsistent. Therefore, we investigated the association between statin therapy and adverse cardiovascular events in a large, prospective VSA cohort. The Variant Angina Korea registry consecutively enrolled 2960 patients suspected VSA. Among them, we included 1713 patients who were diagnosed with VSA based on coronary provocation test. We divided the patients into the statin (n = 744) and no-statin group (n = 914) according to the medication prescribed at discharge. The primary outcome was a composite of cardiac death, acute coronary syndrome, and new-onset life-threatening arrhythmia during a 3-year follow-up period. The primary outcome occurred in 32 patients (4.3%) in the statin and 28 patients (3.1%) in the no-statin group. In Kaplan-Meier analysis before and after propensity score matching, there was no significant difference in the cumulative incidence of primary outcomes between both groups. Multivariate Cox regression analysis demonstrated that the focal type of VSA was independent predictor of primary outcomes, but statin therapy was not. Furthermore, the lack of benefit of statin therapy for primary outcomes was consistently observed across the statin intensity and spasm characteristics. In conclusion, the present study demonstrated that statin therapy did not reduce adverse cardiovascular events in patients with VSA.
