Intensive lipid-lowering therapy uncommon in ACS patients
MedWire News: The majority of patients admitted to hospital with acute coronary syndrome (ACS) do not receive intensive lipid-lowering therapy (LLT), say US researchers who call for better implementation of guideline recommendations.
LLT with statins has been shown in several large studies to reduce cardiovascular risk, regardless of underlying coronary artery disease (CAD), as well as reduce mortality and recurrent cardiac events in patients with stable CAD and ACS. Consequently, it is recommended that LLT be started in patients with ACS before hospital discharge.
To determine the use of LLT at discharge, Prakash Deedwania, from University of California, San Francisco, and colleagues examined data from the Get With The Guidelines database on ACS-related hospitalizations for the period 2005-2009. LLT was defined as a dose of statin or combination therapy likely to produce >50% reduction in low-density lipoprotein (LDL) cholesterol levels.
Of 138,216 patients discharged with ACS during the study period, 86.4% were receiving LLT and 10.3% were discharged without LLT. The remaining 3.3% of patients were contraindicated for LLT. After excluding patients with incomplete data, there were a total of 65,396 admissions at 344 hospitals available for analysis.
The team reports in the American Heart Journal that, of the 65,396 admissions, just 38.3% were treated with an LLT regimen, while the remaining 61.7% received a less intensive LLT (LLLT). While LLT use increased from 2005 to 2007, a decline was observed in 2008 and 2009, due to a reduction in use of ezetimibe-statin combination therapy.
Compared with LLLT patients, those given LLT were more likely to be younger, less likely to be female, and had significantly higher mean total cholesterol, LDL, and triglyceride levels.
LLT administration was low across all levels of LDL, the researchers note. Among patients with LDL levels of 130-160 mg/dl (3.4-4.1 mmol/l), only 43.57% received LLT, rising to 51.98% in those with LDL levels ≥160 mg/dl (4.1 mmol/l).
Multivariate analysis revealed that independent predictors of LLT were LLT before admission, a history of CAD or prior myocardial infarction, hyperlipidemia, LDL per 10 mg/dl (0.26 mmol/l) rise, body mass index increase by 5 units, percutaneous coronary intervention with stent placement, and male gender.
The team concludes: "These findings underscore the importance of ongoing emphasis regarding implementation of current guidelines for measuring lipids and intensive statin therapy in all ACS patients."
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By Liam Davenport