Changes in statin therapy following discharge in those with cardiovascular disease in Ireland

High-intensity statin (HIS) therapy is recommended for all patients with cardiovascular disease, yet many receive sub-optimal lipid-lowering therapy because of non-HIS prescribing or de-escalation in routine care. This study used data from the Irish ASPIRE (I-ASPIRE) survey to examine the frequency and reasons for HIS dose reduction in secondary prevention, and to assess how statin intensity influences LDL-cholesterol (LDL-C) target achievement.

We retrospectively analysed 669 patients with acute or chronic coronary heart disease recruited from cardiology inpatient wards and outpatient clinics at nine Irish centres, with follow-up 6-24 months after the index event. Statin intensity, LDL-C levels and secondary prevention target attainment were compared between patients on HIS and non-HIS at follow-up.

At a mean follow-up of 1.21 years, 64% (428/669) were prescribed HIS, and 21% (140/669) had lipid-lowering therapy down-titrated after discharge. Patients on HIS at follow-up had lower mean LDL-C than those on non-HIS (1.86 vs. 2.16 mmol/L; p < 0.005) and higher rates of guideline LDL-C target achievement. HIS was less frequently prescribed in patients with chronic cardiovascular disease than in those with acute disease (41% vs. 65%; p < 0.05), and more frequently among cardiac rehabilitation attendees (67% vs. 55%; p = 0.014).

These findings show that de-escalation from high-intensity statins is frequent and associated with less favourable LDL-C profiles, identifying potentially avoidable loss of treatment intensity as a modifiable barrier to optimal lipid management in secondary prevention.