Impact of early statin initiation on secondary prevention in Japanese patients with coronary artery disease

• Published in: Journal of cardiology 2011-03, Vol.57 (2), p.172-180
• Main Authors: Nakamura, Michinari, MD, Yamashita, Takeshi, MD, PhD, FJCC, Yajima, Junji, MD, Oikawa, Yuji, MD, Ogasawara, Ken, MD, Sagara, Koichi, MD, Koike, Akira, MD, FJCC, Kirigaya, Hajime, MD, Nagashima, Kazuyuki, MD, Otsuka, Takayuki, MD, Uejima, Tokuhisa, MD, Funada, Ryuichi, MD, Matsuno, Shunsuke, MD, Suzuki, Shinya, MD, Sawada, Hitoshi, MD, FJCC, Aizawa, Tadanori, MD, FJCC
• Format: Article
• Language: English
• Subjects: Aged; Asian Continental Ancestry Group; Cardiovascular; Coronary artery disease; Coronary Artery Disease - mortality; Coronary Artery Disease - prevention & control; Coronary Artery Disease - therapy; Early statin initiation; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Japanese; Male; Middle Aged; Multivariate Analysis; Myocardial Revascularization; Secondary Prevention
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2010.11.004

Summary Background The effect of early statin initiation on secondary prevention remains uncertain in unselected Japanese populations with coronary artery disease (CAD). Methods We investigated the mortality and morbidity in CAD patients according to presence or absence of statins within 3 months after the diagnosis of CAD in the Shinken Database cohort study. The primary endpoint was all-cause mortality. Results Data were available on 789 Japanese patients with CAD (male 78.8%). Among those, 351 patients (44.5%) received a statin. The mean (SD) baseline low-density lipoprotein (LDL)-cholesterol levels were 113.6 (35.7) mg/dL in the statin group and 113.6 (26.4) mg/dL in the non-statin group ( p = 0.992). Unadjusted 2-year survival in patients with or without statins was 98.4% and 92.1%, respectively ( p < 0.001). Among a prespecified subgroup of patients undergoing percutaneous coronary intervention (PCI) ( n = 238 with statins and n = 183 without statins), a consistent effect of statins on 2-year survival was observed (98.5% and 90.9%, respectively, p < 0.001). However, there was no significant difference in 2-year target lesion revascularization-free survival (77.9% in statins versus 73.7% in non-statins, respectively, p = 0.298). The age- and gender-adjusted survival in the PCI subgroup was significantly higher in the statin group [hazard ratio (HR) 0.29, 95% confidence interval (CI) 0.095–0.913] compared to non-statin. Multivariate analysis showed statins significantly reduced mortality (HR 0.27, 95%CI 0.078–0.944), but not revascularization (HR 0.91, 95%CI 0.589–1.406). Conclusions This study suggested that statin therapy initiated early after the diagnosis of CAD can decrease the risk of fatal events in Japanese CAD patients.