OBJECTIVES

: Studies indicate that lower statin doses achieve lipid improvements in Asian patients comparable with higher doses in Caucasians. We aim to evaluate the correlation between lower statin doses and long-term clinical outcome.

METHODS

: We analysed consecutive 2,553 patients (mean age 70.0 ± 13.4 years, 67.6% male) admitted with ACS between August 2010 and July 2014 to 3 hospitals in Hong Kong for a mean follow-up of 30 ± 17 months. There was no change in statin dosage or type. Statin therapy was divided into high (simvastatin (SIM) 80mg, atorvastatin (ATO) 40-80mg, rosuvastatin (ROS) 20-40mg); moderate (SIM 20-40mg, ATO 10-20mg, ROS 5-10mg) and low (SIM 10mg) intensity groups and compared. Outcome measures included achievement of LDL level <1.8mmol/L, all-cause mortality and major adverse cardiac events (MACE).

RESULTS

: Overall, 80.7% (n=2,059) of patients were discharged and remained on the same statin dose of which 6.2%, 62.6% and 31.2% were of high, moderate and low intensity, respectively. Simvastatin (mean dose 20.3mg) was used in 88.2% of cases. Patients with baseline LDL level ≥2.6mmol/L compared to LDL <1.8mmol/L were more likely to be prescribed moderate (68.7% vs. 50.6%) and high (7.4% vs. 4.9%) intensity statin (p<0.01). Achievement of LDL level <1.8mmol/L at follow-up was suboptimal in all groups (low intensity statin 38.1% vs. moderate 40.2% vs. high 50.0%, p=0.07). Neither LDL level at baseline nor follow-up were predictors of MACE at follow-up. Independent predictors of MACE included moderate statin intensity (odds ratio (OR) 0.60, 95%CI 0.44-0.84), STEMI (OR 0.64, 95%CI 0.48-0.86), percutaneous coronary intervention (OR 0.65, 95%CI 0.52-0.82), diabetes mellitus (OR 1.44, 1.15-1.82) and age≥65 years (OR 2.07, 1.59-2.71), all p<0.01.

CONCLUSIONS

: High intensity statin therapy was rarely prescribed in Chinese patients presenting with ACS irrespective of baseline LDL level. Moderate intensity statin therapy was an independent predictor of improved long-term clinical outcomes.