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Effect of statin on long-term outcomes in persistent tobacco users receiving percutaneous coronary intervention: A
Mao-Jen Lin1,2, Hau-De Lin1, Chuan-Zhong Cai1
1Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
Insights
Statin therapy in persistent smokers undergoing percutaneous coronary intervention (PCI) for coronary artery disease (CAD) reduced all-cause mortality. However, smoking may attenuate statins' cardiovascular protective effects.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Public Health
Background:
- Statins are proven to improve cardiovascular outcomes.
- Their long-term effects in persistent smokers with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are not well understood.
Purpose of the Study:
- To investigate the impact of statin therapy on long-term outcomes in persistent tobacco users with stable CAD who received PCI.
- To determine if smoking influences the effectiveness of statins in this patient population.
Main Methods:
- A cohort of 907 persistent smokers with stable CAD undergoing PCI from 2012-2019 was analyzed.
- Statin users and non-statin users were compared for clinical outcomes using Kaplan-Meier curves and Cox proportional hazard models.
- Predictors for all-cause mortality and major adverse cardiovascular events were analyzed.
Main Results:
- Statin users had higher baseline cholesterol levels but achieved lower LDL-C post-treatment.
- Freedom from all-cause and cardiovascular mortality was lower in the non-statin group.
- Statin treatment was associated with reduced all-cause mortality (HR: 0.27) but not cardiovascular mortality after adjustment.
- Smoking appears to attenuate the pleiotropic effects of statins.
Conclusions:
- Statin therapy is associated with reduced all-cause mortality in persistent smokers with CAD undergoing PCI.
- Smoking may diminish the cardiovascular protective benefits of statins.
- Further research is needed to understand the complex interaction between smoking and statin efficacy.
Abstract:
The role of statins in improving cardiovascular outcomes is well established, but little is known about their impacts on long-term outcomes in persistent tobacco users with stable coronary artery disease (CAD) who receive percutaneous coronary intervention (PCI). A population of persistent smokers with CAD treated by PCI was analyzed. From 2012 through 2019, a cohort of 907 persistent tobacco users with stable CAD undergoing PCI were enrolled from the inpatient department of Taichung Tzu Chi Hospital, Taiwan. We surveyed statin users and non-statin users after index PCI, and general characteristics, major risk factors, angiographic findings, and long-term clinical outcome were compared. Kaplan-Meier curve was used to compare the survival difference and Cox proportional hazard model was used to analyze the predictors for all-cause mortality and major adverse cardiovascular events, including cardiovascular (CV) mortality, myocardial infarction, and repeated PCI procedures. The statin group had a higher average total cholesterol (P < .01) and low-density lipoprotein cholesterol (LDL-C) level (P < .01) and was younger (P < .01) than the non-statin group. Ninety-six point one percent patients in the statin group had a LDL-C level below 100 mg/dL after treatment. They also had a more frequent history of acute coronary syndrome and lower prevalence of chronic kidney disease than the non-statin group (both P < .01). Freedom from all-cause and CV mortality were lower in the non-statin group than the statin group (both P < .01). After adjustment for age and chronic kidney disease, statin treatment no longer reduced the risk of CV mortality (hazard ratio: 0.32, 95% confidence interval = 0.07-1.49), but was still associated with a reduction in all-cause mortality (hazard ratio: 0.27, 95% confidence interval = 0.10-0.75). In persistent tobacco users undergoing PCI, patients treated with statin for LDL-C values above 100 mg/dL had a similar level of cardiovascular protection as those with LDL-C below 100 mg/dL and without statin treatment. Therefore, smoking attenuates pleiotropic effect of statin. Nevertheless, statin therapy was still associated with a reduction of all-cause mortality.
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