Association of Contemporary Statin Pretreatment Intensity and LDL-C Levels on the Incidence of STEMI Presentation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Patients’ Inclusion/Exclusion/Withdrawal Criteria
2.3. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Association between Statin Therapy, LDL-C Levels and ACS Type
3.3. Association between Statin and Ezetimibe Therapy and ACS Type
3.4. Multivariate Analyses for STEMI Presentation
4. Discussion
4.1. Prior Studies
4.2. Statin Intensity and Plaque Characteristics
4.3. STEMI Presentation in Reduced LDL-C Levels Settings
4.4. HIST in Primary and Secondary Prevention
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Statin-Naive n = 2839 | Statin-Treated n = 2264 | p-Value 1 | Low Intensity n = 1389 | High Intensity n = 875 | p-Value 2 |
---|---|---|---|---|---|---|
Patients’ characteristics | ||||||
Age, years (mean ± SD) | 61.4 ± 13.15 | 66.1 ± 11.7 | <0.001 | 67.0 ± 11.9 | 64.8 ± 11.4 | <0.001 |
Female sex, n (%) | 508 (17.9) | 546 (24.1) | <0.001 | 372 (26.8) | 174 (19.9) | <0.001 |
Medical history | ||||||
Diabetes mellitus, n (%) | 766 (27.0) | 1142 (50.4) | <0.001 | 655 (47.2) | 487 (55.7) | <0.001 |
Hypertension, n (%) | 1412 (49.7) | 1761 (77.8) | <0.001 | 1052 (75.7) | 709 (81.0) | 0.004 |
Current smoker, n (%) | 1334 (47.0) | 712 (31.4) | <0.001 | 397 (28.6) | 315 (36.0) | <0.001 |
CAD family history, n (%) | 800 (28.2) | 590 (26.1) | 0.097 | 339 (24.4) | 251 (28.7) | 0.027 |
Dyslipidemia, n (%) | 1522 (53.6) | 2139 (94.5) | <0.001 | 1322 (95.2) | 817 (93.4) | 0.082 |
CKD, n (%) | 202 (7.1) | 373 (16.5) | <0.001 | 210 (15.1) | 163 (18.6) | <0.001 |
Prior MI, n (%) | 486 (17.1) | 1185 (52.3) | <0.001 | 606 (43.6) | 579 (66.2) | <0.001 |
Past PCI/CABG, n (%) | 464 (16.3) | 1302 (57.5) | <0.001 | 690 (49.7) | 612 (69.9) | <0.001 |
Past CVA/TIA, n (%) | 160 (5.6) | 251 (11.1) | <0.001 | 144 (10.4) | 107 (12.2) | 0.192 |
PVD, n (%) | 139 (4.9) | 246 (10.8) | <0.001 | 137 (9.9) | 109 (12.5) | 0.063 |
Chronic medical treatment | ||||||
ACE-I/ARB, n (%) | 617 (21.7) | 1380 (61.0) | <0.001 | 788 (56.7) | 592 (67.7) | <0.001 |
Aspirin, n (%) | 598 (21.1) | 1687 (74.5) | <0.001 | 981 (70.6) | 706 (80.7) | <0.001 |
Clopidogrel, n (%) | 85 (3.0) | 461 (20.4) | <0.001 | 213 (15.3) | 248 (28.3) | <0.001 |
Anti-platelets, n (%) | 99 (3.5) | 528 (23.3) | <0.001 | 220 (15.8) | 308 (35.2) | <0.001 |
Ezetimibe, n (%) | 20 (0.7) | 83 (3.7) | <0.001 | 27 (1.9) | 56 (6.4) | <0.001 |
Beta blockers, n (%) | 454 (16.0) | 1300 (57.4) | <0.001 | 741 (53.3) | 559 (63.9) | <0.001 |
Presenting characteristics | ||||||
STEMI diagnosis, n (%) | 1533 (54.0) | 796 (35.2) | <0.001 | 525 (37.8) | 271 (31.0) | 0.001 |
Killip class > I, n (%) | 267 (9.4) | 290 (12.8) | 0.001 | 180 (13.0) | 110 (12.6) | 0.838 |
HR (bpm), median (IQR) | 78 (68, 90) | 78 (67, 90) | 0.602 | 77 (66, 90) | 79 (68, 91) | 0.057 |
SBP (mmHg), median (IQR) | 140 (123, 159) | 140 (124, 160) | 0.044 | 140 (124, 160) | 141 (125, 160) | 0.365 |
Lipid profile | ||||||
TC (mg/dL), median (IQR) | 181 (153, 211) | 155 (131, 183) | <0.001 | 157 (134, 184) | 151 (126, 182) | 0.027 |
LDL (mg/dL), median (IQR) | 113 (89, 139) | 86 (67, 110) | <0.001 | 88 (68, 109) | 84 (63, 112) | 0.400 |
HDL (mg/dL), median (IQR) | 38 (32, 46) | 38 (32, 46) | 0.610 | 39 (32, 47) | 37 (30, 44) | 0.230 |
TG (mg/dL), median (IQR) | 124 (89, 176) | 129 (91, 185) | 0.005 | 128 (89, 181) | 130 (95, 188) | 0.162 |
LDL-C Subgroups (mg/dL) | <55 | 55–69 | 70–99 | 100–129 | >130 | All | p for Trend |
---|---|---|---|---|---|---|---|
A. All patients | |||||||
n | 466 | 477 | 1602 | 1315 | 1243 | 5103 | |
STEMI rates, n (%) | 160 (34.3) | 182 (38.2) | 687 (42.9) | 637 (48.4) | 663 (53.3) | 2329 (45.6) | <0.001 |
B. Statin naive patients | |||||||
n | 145 | 153 | 750 | 846 | 945 | 2839 | |
STEMI rates, n (%) | 58 (40.0) | 76 (49.7) | 401 (53.5) | 465 (55.0) | 533 (56.4) | 1533 (54.0) | 0.001 |
C. Statin treated patients | |||||||
n | 321 | 324 | 852 | 469 | 298 | 2264 | |
STEMI rates, n (%) | 102 (31.8) | 106 (32.7) | 286 (33.6) | 172 (36.7) | 130 (43.6) | 796 (35.2) | 0.001 |
D. Low-intensity statin treated patients | |||||||
n | 149 | 213 | 558 | 307 | 162 | 1389 | 0.032 |
STEMI rates, n (%) | 52 (34.9) | 75 (35.2) | 206 (36.9) | 116 (37.8) | 76 (46.9) | 525 (37.8) | |
E. High-intensity statin treated patients | |||||||
n | 172 | 111 | 294 | 162 | 136 | 875 | |
STEMI rates, n (%) | 50 (29.1) | 31 (27.9) | 80 (27.2) | 56 (34.6) | 54 (39.7) | 271 (31.0) | 0.028 |
Variable | Multivariate Analysis | |||
---|---|---|---|---|
OR a | 95% CI | p Value | c-Statistics | |
Model 1: Propensity score quintiles | 0.632 | |||
1 (reference) | 1.0 | |||
2 (vs. 1st quintile) | 0.88 | 0.74–1.06 | 0.65 | |
3 (vs. 1st quintile) | 0.65 | 0.54–0.78 | <0.001 | |
4 (vs. 1st quintile) | 0.42 | 0.35–0.51 | <0.001 | |
5 (vs. 1st quintile) | 0.26 | 0.21–0.31 | <0.001 | |
Model 2: | 0.635 | |||
Propensity score | 0.31 | 0.24–0.39 | <0.001 | |
Low-intensity statins (vs. statin-naive) | 0.92 | 0.77–1.10 | 0.37 | |
High-intensity statins (vs. statin-naive) | 0.70 | 0.57–0.86 | 0.001 | |
LDL-C < 70 mg/dL (vs. ≥70) | 0.96 | 0.82–1.14 | 0.67 | |
Model 3 b: | 0.648 | |||
Propensity score | 0.66 | 0.45–0.96 | 0.03 | |
Low-intensity statins (vs. statin-naive) | 0.88 | 0.74–1.05 | 0.17 | |
High-intensity statins (vs. statin-naive) | 0.75 | 0.61–0.93 | 0.01 | |
LDL-C < 70 mg/dL (vs. ≥70) | 0.94 | 0.80–1.11 | 0.49 | |
Chronic aspirin (yes vs. no) | 0.92 | 0.76–1.10 | 0.36 | |
Chronic clopidogrel (yes vs. no) | 0.58 | 0.46–0.73 | <0.001 | |
Chronic ACE-I/ARB (yes vs. no) | 0.77 | 0.66–0.89 | <0.001 | |
Chronic Beta-blocker (yes vs. no) | 0.71 | 0.63–0.83 | <0.001 |
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Dadon, Z.; Moriel, M.; Iakobishvili, Z.; Asher, E.; Samuel, T.Y.; Gavish, D.; Glikson, M.; Gottlieb, S. Association of Contemporary Statin Pretreatment Intensity and LDL-C Levels on the Incidence of STEMI Presentation. Life 2021, 11, 1268. https://doi.org/10.3390/life11111268
Dadon Z, Moriel M, Iakobishvili Z, Asher E, Samuel TY, Gavish D, Glikson M, Gottlieb S. Association of Contemporary Statin Pretreatment Intensity and LDL-C Levels on the Incidence of STEMI Presentation. Life. 2021; 11(11):1268. https://doi.org/10.3390/life11111268
Chicago/Turabian StyleDadon, Ziv, Mady Moriel, Zaza Iakobishvili, Elad Asher, Tal Y. Samuel, Dov Gavish, Michael Glikson, and Shmuel Gottlieb. 2021. "Association of Contemporary Statin Pretreatment Intensity and LDL-C Levels on the Incidence of STEMI Presentation" Life 11, no. 11: 1268. https://doi.org/10.3390/life11111268