Niteesh K Choudhry1, Raisa Levin, Wolfgang C Winkelmayer. 1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. nchoudhry@partners.org
Abstract
OBJECTIVE: To compare the effectiveness of statins of different treatment intensity used to treat elderly patients with acute coronary syndrome (ACS) in typical care settings. DESIGN: Retrospective cohort study using linked hospital and pharmacy claims data. SETTING: Statewide pharmacy benefits programmes in Pennsylvania and New Jersey. PARTICIPANTS: 18,311 Medicare patients discharged alive after ACS who received a prescription for a statin within 90 days of hospital discharge. MAIN OUTCOME MEASURES: Using multivariable and propensity-matched Cox proportional hazards regression models, patients who were prescribed high-intensity and moderate-intensity statins were compared based on the drug-dose combination that they initially received. Individual drug-dose combinations were also compared. Our primary outcome was the composite of all-cause death or recurrent ACS. RESULTS: Patients who received moderate-intensity statins were as likely to experience a primary outcome as patients treated with high-intensity statins (adjusted HR 1.02, 95% CI 0.96 to 1.08). Propensity matching did not change the results. Individually, all moderate-intensity statins were as effective as high-intensity atorvastatin with the exception of lovastatin (adjusted HR 1.22, 95% CI 1.09 to 1.36). Similarly, all high-intensity statins seem as effective as high-intensity atorvastatin but the CIs surrounding these estimates were wide. CONCLUSIONS: This analysis of elderly patients with ACS treated in typical care settings does not demonstrate the superiority of high-intensity over moderate-intensity statin treatment or significant differences among individual statins.
OBJECTIVE: To compare the effectiveness of statins of different treatment intensity used to treat elderly patients with acute coronary syndrome (ACS) in typical care settings. DESIGN: Retrospective cohort study using linked hospital and pharmacy claims data. SETTING: Statewide pharmacy benefits programmes in Pennsylvania and New Jersey. PARTICIPANTS: 18,311 Medicare patients discharged alive after ACS who received a prescription for a statin within 90 days of hospital discharge. MAIN OUTCOME MEASURES: Using multivariable and propensity-matched Cox proportional hazards regression models, patients who were prescribed high-intensity and moderate-intensity statins were compared based on the drug-dose combination that they initially received. Individual drug-dose combinations were also compared. Our primary outcome was the composite of all-cause death or recurrent ACS. RESULTS:Patients who received moderate-intensity statins were as likely to experience a primary outcome as patients treated with high-intensity statins (adjusted HR 1.02, 95% CI 0.96 to 1.08). Propensity matching did not change the results. Individually, all moderate-intensity statins were as effective as high-intensity atorvastatin with the exception of lovastatin (adjusted HR 1.22, 95% CI 1.09 to 1.36). Similarly, all high-intensity statins seem as effective as high-intensity atorvastatin but the CIs surrounding these estimates were wide. CONCLUSIONS: This analysis of elderly patients with ACS treated in typical care settings does not demonstrate the superiority of high-intensity over moderate-intensity statin treatment or significant differences among individual statins.
Authors: A W Weverling-Rijnsburger; G J Blauw; A M Lagaay; D L Knook; A E Meinders; R G Westendorp Journal: Lancet Date: 1997-10-18 Impact factor: 79.321
Authors: Zheng Zhou; Elham Rahme; Michal Abrahamowicz; Jack V Tu; Mark J Eisenberg; Karin Humphries; Peter C Austin; Louise Pilote Journal: CMAJ Date: 2005-04-26 Impact factor: 8.262
Authors: Philip S Wang; Sebastian Schneeweiss; Jerry Avorn; Michael A Fischer; Helen Mogun; Daniel H Solomon; M Alan Brookhart Journal: N Engl J Med Date: 2005-12-01 Impact factor: 91.245
Authors: F M Sacks; M A Pfeffer; L A Moye; J L Rouleau; J D Rutherford; T G Cole; L Brown; J W Warnica; J M Arnold; C C Wun; B R Davis; E Braunwald Journal: N Engl J Med Date: 1996-10-03 Impact factor: 91.245
Authors: James A de Lemos; Michael A Blazing; Stephen D Wiviott; Eldrin F Lewis; Keith A A Fox; Harvey D White; Jean-Lucien Rouleau; Terje R Pedersen; Laura H Gardner; Robin Mukherjee; Karen E Ramsey; Joanne Palmisano; David W Bilheimer; Marc A Pfeffer; Robert M Califf; Eugene Braunwald Journal: JAMA Date: 2004-08-30 Impact factor: 56.272
Authors: Elliott M. Antman; Daniel T. Anbe; Paul Wayne Armstrong; Eric R. Bates; Lee A. Green; Mary Hand; Judith S. Hochman; Harlan M. Krumholz; Frederick G. Kushner; Gervasio A. Lamas; Charles J. Mullany; Joseph P. Ornato; David L. Pearle; Michael A. Sloan; Sidney C. Smith; Joseph S. Alpert; Jeffrey L. Anderson; David P. Faxon; Valentin Fuster; Raymond J. Gibbons; Gabriel Gregoratos; Jonathan L. Halperin; Loren F. Hiratzka; Sharon Ann Hunt; Alice K. Jacobs; Joseph P. Ornato Journal: J Am Coll Cardiol Date: 2004-08-04 Impact factor: 24.094
Authors: Qing Huang; Michael Grabner; Robert J Sanchez; Vincent J Willey; Mark J Cziraky; Swetha R Palli; Thomas P Power Journal: Am Health Drug Benefits Date: 2016-11
Authors: Andrea V Margulis; Niteesh K Choudhry; Colin R Dormuth; Sebastian Schneeweiss Journal: Pharmacoepidemiol Drug Saf Date: 2011-04-28 Impact factor: 2.890
Authors: Zhen Zhou; Andrea J Curtis; Michael E Ernst; Joanne Ryan; Sophia Zoungas; Rory Wolfe; John J McNeil; Anne M Murray; Christopher M Reid; Enayet K Chowdhury; Robyn L Woods; Andrew M Tonkin; Mark R Nelson Journal: Eur J Clin Pharmacol Date: 2021-10-26 Impact factor: 2.953
Authors: Sebastian Schneeweiss; Jeremy A Rassen; Robert J Glynn; Jessica Myers; Gregory W Daniel; Joseph Singer; Daniel H Solomon; Seoyoung Kim; Kenneth J Rothman; Jun Liu; Jerry Avorn Journal: BMC Med Res Methodol Date: 2012-11-26 Impact factor: 4.615