Jonas Banefelt1, Maria Lindh1, Maria K Svensson2,3, Björn Eliasson4, Ming-Hui Tai5. 1. Quantify Research, Hantverkargatan 8, Stockholm 11221, Sweden. 2. Amgen AB Sweden, Gustav III:s Boulevard 54, 169 74 Solna, Sweden. 3. Department of Medical Sciences, Uppsala University, Akademiska sjukhuset, ingång 40, 5 tr, 751 85 Uppsala, Sweden. 4. Department of Medicine, University of Gothenburg, Sahlgrenska University Hospital, S-41345 Göteborg, Sweden. 5. Amgen, Inc, 1 Amgen Center Dr, Thousand Oaks, CA 91320, USA.
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 < 0.01]. Delayed up-titration was associated with a smaller reduction (HR 0.88, P = 0.08). The majority of patients did not up-titrate. CONCLUSION: Early up-titration to high-intensity statins was independently associated with lower risk of subsequent CV events compared to no up-titration. Delayed up-titration was not associated with the same benefit. Despite the higher risk associated with no up-titration, few patients at very high CV risk who started treatment on moderate-intensity up-titrated to high intensity, indicating a potential need for more aggressive lipid management of these patients in clinical practice. Published on behalf of the European Society of Cardiology. All rights reserved.
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 < 0.01]. Delayed up-titration was associated with a smaller reduction (HR 0.88, P = 0.08). The majority of patients did not up-titrate. CONCLUSION: Early up-titration to high-intensity statins was independently associated with lower risk of subsequent CV events compared to no up-titration. Delayed up-titration was not associated with the same benefit. Despite the higher risk associated with no up-titration, few patients at very high CV risk who started treatment on moderate-intensity up-titrated to high intensity, indicating a potential need for more aggressive lipid management of these patients in clinical practice. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Saadiq M Moledina; Ahmad Shoaib; Louise Y Sun; Phyo K Myint; Rafail A Kotronias; Benoy N Shah; Chris P Gale; Hude Quan; Rodrigo Bagur; Mamas A Mamas Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-09-05
Authors: Maria K Svensson; Francesc Sorio Vilela; Margrét Leósdóttir; Jonas Banefelt; Maria Lindh; Alexander Rieem Dun; Anna Norhammar; Guillermo Villa Journal: Ups J Med Sci Date: 2022-05-04 Impact factor: 2.646
Authors: Emil Hagström; Francesc Sorio Vilela; Maria K Svensson; Sara Hallberg; Emma Söreskog; Guillermo Villa Journal: Adv Ther Date: 2021-07-26 Impact factor: 4.070