Safety and efficacy of high-potency statin in Chinese patients with established cardiovascular disease

Drugs & Therapeutics
HKPharm J Volume 30 (3), Sep-Dec-2023 (2024-02-19): P.70

TANG, HO Yeung1 ; LAU, Kai Cheong1 ; YAN, Bryan P.2; LEE, Vivian W.Y.3*

1.  School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

2.  Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

3.  Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Hong Kong SAR, China

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https://hkpj.org/en/blog-detail.php?id=58&vol=74

ABSTRACT

Clinical guidelines recommend the use of high-intensity statins in patients with acute coronary syndrome (ACS).  Yet, most clinical trials were conducted in mainly Caucasian population.  This study investigated the relationship between statin intensity (low, moderate or high potency), low-density lipoprotein cholesterol (LDL-C) goal attainment and safety outcomes within 1 year of statin therapy in Chinese ACS patients.

A retrospective study was conducted at the Prince of Wales Hospital during 1 August 2010 to 13 November 2014. Efficacy outcomes include percentage LDL reduction, target lesion revascularization (TLR) and ACS-related accident & emergency department(AED) readmission. Composite safety outcomes include myopathy, liver function test derangement and impaired glycemic control were evaluated.

A total of 357 ACS patients were recruited. Low-, moderate- and high-intensity statins can achieve 21% (95% CI: 11.1% to 30.9%), 32.8% (95% CI: 26.9% to 38.7%), 57.8% (95% CI: 48.1% to 67.4%) LDL-C reduction respectively. Using high-intensity statins is more likely than moderate-intensity statins to achieve ≥50% LDL-C reduction respectively (OR: 9.437, 95% CI: 4.028 to 22.107) (p < 0.0001). High-intensity statins are more likely to achieve LDL-C <1.8mmol/L than moderate-intensity statins (OR: 6.398, 95% CI: 2.716 to 15.072) (p < 0.0001). Low-intensity statins are not significantly different from moderate-intensity to achieve LDL-C <1.8mmol/L (OR: 0.559, 95% CI: 0.305 to 1.026) (p = 0.061). The relationship between statin intensity and LDL-C goal attainment was adjusted for age, gender, smoking status, alcohol consumption, family history of ACS, baseline LDL-C and regular exercise of subjects.  High-intensity statin users were more likely than moderate-intensity statin users to have impaired fasting blood glucose and HbA1c (OR: 2.495, 95% CI: 1.048 to 5.94; OR: 2.805, 95% CI: 1.143 to 6.883) (p = 0.039; p = 0.024). A total of 42 (11.8%) TLR or ACS-related AED readmission were recorded.   There was no significant difference in the composite endpoint between low-potency statin users and moderate-potency statin users (OR 0.61, 95% CI 0.24-1.55, P=0.298) or between high-potency statin users and moderate-potency statin users (OR 0.42, 95% CI 0.09-1.92, P=0.263).   High-intensity statins are more likely than moderate-intensity statins to have impaired fasting blood glucose and HaemoglobinA1C (OR: 2.495, 95% CI: 1.048 to 5.94; OR: 2.805, 95% CI: 1.143 to 6.883) (p = 0.039; p = 0.024).

The present study showed that high-intensity statins result in greater LDL-C reduction and more adverse effects than statins of lower intensity. However, statin intensity and LDL-C goal attainment have no significant effects on the incidence and time-to-event of the efficacy outcomes.