Association of Prior Statin Therapy With Cardiovascular Outcomes in Patients With Initial Diagnosis of OCAD and LDL-C Below 1.8 mmol/L

Abstract

This study investigated the effect of prior statin therapy on cardiovascular outcomes in patients with a diagnosis of obstructive coronary artery disease (OCAD) and low-density lipoprotein cholesterol (LDL-C) <1.8 mmol/L. A total of 1330 patients with baseline LDL-C <1.8 mmol/L were included; 548 had received prior statin therapy [prior statin (+)] and 782 had no prior statin [prior statin (−)]. Major adverse cardiac and cerebral event (MACCE) during hospitalization and a median follow-up of 25 months were analyzed. Compared with the prior statin (−) group, who displayed similar atherosclerotic cardiovascular disease risk burden including 71.6% with hypertension, 39.1% with diabetes, and 76.1% with ≥3 risk factors, the prior statin (+) group had significantly lower incidence of composite MACCE, all-cause death and cardiovascular death. After multivariable adjustment, non-prior statin therapy was independently associated with all-cause death [hazard ratio (HR) 2.09, 95% confidence interval (CI), 1.13-3.87, P = .019] and cardiovascular death (HR 2.28, 95% CI, 1.04-5.00, P = .040), particularly in the subgroups aged ≥65 years and with hypertension. Overall, compared with "naturally" LDL-C <1.8 mmol/L without statin, prior statin therapy to achieve an LDL-C <1.8 mmol/L independently predicted a lower risk of all-cause and cardiovascular mortality in patients with a diagnosis of OCAD.