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

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• 作者：Michinari Nakamura MD^a ; ^{nmichi-kyu@umin.ac.jp} ; Takeshi Yamashita MD ; PhD ; FJCC^a ; Junji Yajima MD^a ; Yuji Oikawa MD^a ; Ken Ogasawara MD^a ; Koichi Sagara MD^a ; Akira Koike MD ; FJCC^a ; Hajime Kirigaya MD^a ; Kazuyuki Nagashima MD^a ; Takayuki Otsuka MD^a ; Tokuhisa Uejima MD^a ; Ryuichi Funada MD^a ; Shunsuke Matsuno MD^a ; Shinya Suzuki MD^b ; Hitoshi Sawada MD ; FJCC^a ; Tadanori Aizawa MD ; FJCC^a ; the Shinken Database Study Group
• 关键词：Early statin initiation ; Coronary artery disease ; Secondary prevention ; Japanese
• 刊名：Journal of Cardiology
• 出版年：2011
• 出版时间：March 2011
• 年：2011
• 卷：57
• 期：2
• 页码：172-180
• 全文大小：221 K

文摘

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.