FDA announces new safety recommendations for high-dose simvastatin Sept. 2015
Greater intensity of statin therapy confers increased mortality benefit
In a retrospective analysis published in JAMA Cardiology,
high-intensity statin use was associated with a survival benefit
compared with moderate-intensity statin use, especially if maximal doses
of high-intensity statins were taken.
The researchers analyzed 509,766 adults aged 21 to 84 years (mean
age, 69 years; 499,598 men) with atherosclerotic CVD treated in the
Veterans Affairs health care system from April 2013 to April 2014 to
assess the relationship between intensity of statin therapy and mortality.
In the cohort, 29.6% of patients were prescribed a high-intensity statin, 45.6% a moderate-intensity statin, 6.7% a low-intensity statin and 18.2% no statins.
After mean follow-up of 492 days, 4% of those prescribed a high-intensity statin died vs. 4.8% of those receiving a moderate-intensity statin, 5.7% of those receiving a low-intensity statin and 6.6% of those receiving no statins (P < .001), Fatima Rodriguez, MD, MPH, from the division of cardiovascular medicine and the Cardiovascular Institute, Stanford University, and colleagues wrote.
When Rodriguez and colleagues adjusted for propensity to receive high-intensity statin therapy, those who received high-intensity statins remained at lower risk for death vs. those who received moderate-intensity statins (adjusted HR = 0.91; 95% CI, 0.88-0.93).
Among patients who had received their first statin prescription within the prior 6 months, the effect of intensity on survival was slightly less (adjusted HR = 0.93; 95% CI, 0.85-1.01), according to the researchers.
The effect of statin intensity on survival was similar in those aged 75 years or younger (HR = 0.9; 95% CI, 0.88-0.93) and in those aged 76 to 84 years (HR = 0.91; 95% CI, 0.87-0.95).
Among those receiving high-intensity statins, those taking maximal
doses had less risk for death compared with those not taking maximal
doses (HR = 0.9; 95% CI, 0.87-0.94), the researchers wrote.
Although the relationship between statin intensity and mortality was not seen in randomized controlled trials, “it is ... possible that this study detected a signal not found in the [randomized controlled trials] because of its very large sample size relative to [randomized controlled trials] and because it involves a broader population, including patients older than 75 years,” Robert O. Bonow, MD, MS, editor of JAMA Cardiology, and Clyde W. Yancy, MD, MSc, deputy editor of JAMA Cardiology, wrote in an editor’s note.
“We find these findings confirmatory that high-intensity statin
therapy when appropriate is beneficial for secondary prevention, and
these benefits are seen even in older persons,” Bonow and Yancy, both
from Northwestern University Feinberg School of Medicine, wrote. – by Erik Swain
Disclosure: The researchers, Bonow and Yancy report no relevant financial disclosures.
In the cohort, 29.6% of patients were prescribed a high-intensity statin, 45.6% a moderate-intensity statin, 6.7% a low-intensity statin and 18.2% no statins.
After mean follow-up of 492 days, 4% of those prescribed a high-intensity statin died vs. 4.8% of those receiving a moderate-intensity statin, 5.7% of those receiving a low-intensity statin and 6.6% of those receiving no statins (P < .001), Fatima Rodriguez, MD, MPH, from the division of cardiovascular medicine and the Cardiovascular Institute, Stanford University, and colleagues wrote.
When Rodriguez and colleagues adjusted for propensity to receive high-intensity statin therapy, those who received high-intensity statins remained at lower risk for death vs. those who received moderate-intensity statins (adjusted HR = 0.91; 95% CI, 0.88-0.93).
Among patients who had received their first statin prescription within the prior 6 months, the effect of intensity on survival was slightly less (adjusted HR = 0.93; 95% CI, 0.85-1.01), according to the researchers.
The effect of statin intensity on survival was similar in those aged 75 years or younger (HR = 0.9; 95% CI, 0.88-0.93) and in those aged 76 to 84 years (HR = 0.91; 95% CI, 0.87-0.95).
Robert O. Bonow
Although the relationship between statin intensity and mortality was not seen in randomized controlled trials, “it is ... possible that this study detected a signal not found in the [randomized controlled trials] because of its very large sample size relative to [randomized controlled trials] and because it involves a broader population, including patients older than 75 years,” Robert O. Bonow, MD, MS, editor of JAMA Cardiology, and Clyde W. Yancy, MD, MSc, deputy editor of JAMA Cardiology, wrote in an editor’s note.
Clyde W. Yancy
Disclosure: The researchers, Bonow and Yancy report no relevant financial disclosures.
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