Statin dose titration patterns and subsequent major cardiovascular events in very high-risk patients: estimates from Swedish population-based registry data

Abstract Aims Clinical studies have demonstrated the efficacy of intensive statin therapy in lowering low-density lipoprotein cholesterol and cardiovascular (CV) events. Our objective was to examine statin titration patterns and the association between titration patterns and subsequent CV events in...

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Bibliographic Details
Published in:European heart journal. Quality of care & clinical outcomes 2020-10, Vol.6 (4), p.323-331
Main Authors: Banefelt, Jonas, Lindh, Maria, Svensson, Maria K, Eliasson, Björn, Tai, Ming-Hui
Format: Article
Language:English
Subjects:
ASCVD
Biotechnology industry
Cardiac patients
Cardiovascular agents
Cardiovascular disease
Cardiovascular outcomes
Care and treatment
Cholesterol
Disease prevention
Drug dosages
Endocrinology and Diabetes
Endokrinologi och diabetes
Heart attack
Low density lipoproteins
MACE
Medical research
Medicine, Experimental
Secondary prevention
Statin titration
Statins
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Summary:Abstract Aims Clinical studies have demonstrated the efficacy of intensive statin therapy in lowering low-density lipoprotein cholesterol and cardiovascular (CV) events. Our objective was to examine statin titration patterns and the association between titration patterns and subsequent CV events in very high-risk patients. Methods and results Using Swedish national population-based registry data, we identified 192 435 patients with very high risk of atherosclerotic CV disease initiated on moderate-intensity statin therapy between 2006 and 2013. Outcomes of interest were titration to high-intensity therapy and the major adverse cardiovascular events (MACE) composite (myocardial infarction, ischaemic stroke, and CV death) outcome. Cumulative incidence of MACE was assessed by titration status 1-year post-treatment initiation in patients adherent to treatment during the first year, using a 12-week cut-off from initiation to define early, delayed and no up-titration to high-intensity statins. Cox regression analysis was used to estimate adjusted hazard ratios (HRs). In 144 498 eligible patients, early titration was associated with significantly lower risk of MACE in the subsequent 2 years compared to no up-titration (HR 0.76, P 
ISSN:2058-5225
2058-1742
2058-1742
DOI:10.1093/ehjqcco/qcaa023