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Reduction of Myocardial Infarction and All-Cause Mortality Associated to Statins in Patients Without Obstructive CAD
Kristian A Øvrehus1, Axel Diederichsen1, Erik L Grove2
1Department of Cardiology, Odense University Hospital, Odense, Esbjerg, Denmark; Department of Clinical Medicine, Health, University of Southern Denmark, Odense, Denmark.
Insights
Statin therapy significantly reduces the risk of myocardial infarction (MI) and death in patients with no or nonobstructive coronary artery disease (CAD). The benefit of statins increases with the severity of coronary artery disease burden.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Limited data exists on the prognostic impact of statin use in patients diagnosed with no or nonobstructive coronary artery disease (CAD) via coronary computed tomographic angiography (CTA).
- Assessing the role of statins in this patient group is crucial for optimizing cardiovascular risk management.
Purpose of the Study:
- To evaluate the prognostic significance of statin therapy in symptomatic individuals without obstructive coronary artery disease (CAD).
- To determine the association between statin use and cardiovascular outcomes in patients with varying degrees of nonobstructive CAD.
Main Methods:
- Retrospective analysis of 33,552 patients undergoing coronary computed tomographic angiography (CTA) for suspected coronary artery disease (CAD) between 2008 and 2017.
- Data on post-CTA statin therapy and cardiovascular events (myocardial infarction, all-cause mortality) were collected from national registries.
- Patients were categorized based on the absence or severity of nonobstructive CAD (coronary artery calcium score).
Main Results:
- The absolute risk of myocardial infarction (MI) or all-cause mortality was directly correlated with the burden of coronary artery disease (CAD), ranging from 4.13 to 32.47 events per 1,000 patient-years across no, mild, moderate, and severe nonobstructive CAD.
- Statin therapy demonstrated a significant reduction in the risk of MI and death, with multivariable adjusted hazard ratios ranging from 0.44 to 0.52 across all categories of nonobstructive CAD.
- The number of patients needed to treat with statins to prevent one primary endpoint event decreased as the CAD burden increased, from 92 in no CAD to 13 in severe nonobstructive CAD.
Conclusions:
- The risk of MI and all-cause mortality in patients without obstructive CAD is directly associated with the extent of CAD.
- Statin therapy is linked to a reduced risk of MI and all-cause death across the spectrum of nonobstructive CAD.
- The absolute benefit of statin treatment is proportionally greater in patients with a higher burden of nonobstructive coronary artery disease.
Objectives:
The aim of this work was to evaluate the prognostic impact of statin therapy in symptomatic patients without obstructive CAD.
Background:
Information on the prognostic impact of post-coronary computed tomographic angiography (CTA) statin use in patients with no or nonobstructive coronary artery disease (CAD) is sparse.
Methods:
Patients undergoing CTA with suspected CAD in western Denmark from 2008 to 2017 with <50% coronary stenoses were identified. Information on post-CTA use of statin therapy and cardiovascular events were obtained from national registries.
Results:
The study included 33,552 patients, median aged 56 years, 58% female, with no (n = 19,669) or nonobstructive (n = 13,883) CAD and a median follow-up of 3.5 years. The absolute risk of the combined end point of myocardial infarction (MI) or all-cause mortality was directly associated with the CAD burden with an event rate/1,000 patient-years of 4.13 (95% CI: 3.69-4.61) in no, 7.74 (95% CI: 6.88-8.71) in mild (coronary artery calcium score [CACS] 0-99), 13.72 (95% CI: 11.61-16.23) in moderate (CACS 100-399), and 32.47 (95% CI: 26.25-40.16) in severe (CACS ≥400) nonobstructive CAD. Statin therapy was associated with a multivariable adjusted HR for MI and death of 0.52 (95% CI: 0.36-0.75) in no, 0.44 (95% CI: 0.32-0.62) in mild, 0.51 (95% CI: 0.34-0.75) in moderate, and 0.52 (95% CI: 0.32-0.86) in severe nonobstructive CAD. The estimated numbers needed to treat to prevent the primary end point were 92 (95% CI: 61-182) in no, 36 (95% CI: 26-58) in mild, 24 (95% CI: 15-61) in moderate, and 13 (95% CI: 7-86) in severe nonobstructive CAD. Residual confounding may persist, but not to an extent explaining all of the observed risk reduction associated with statin treatment.
Conclusions:
The risk of MI and all-cause mortality in patients without obstructive CAD is directly associated with the CAD burden. Statin therapy is associated with a reduction of MI and all-cause death across the spectrum of CAD, however, the absolute benefit of treatment is directionally proportional with the CAD burden.
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