Introduction
A high-intensity statin, defined as atorvastatin 40mg or 80mg and
rosuvastatin 20mg or 40mg orally, which lowers low-density lipoprotein
cholesterol (LDL-C) by ≥50%, is recommended by clinical practice
guidelines for secondary prevention of cardiovascular events among
patients who have an atherosclerotic cardiovascular disease (CVD) (Class
1A).1,2 Several clinical trials have demonstrated that
statin use reduces major cardiovascular events.3–10Specifically, large randomized controlled clinical trials have
established the efficacy and safety of statins for secondary prevention
of CVDs.8–10 The Intensive versus Moderate Lipid
Lowering with Statins after Acute Coronary Syndromes (PROVE IT) trial
that compared atorvastatin 80mg to pravastatin 40mg demonstrated a risk
reduction of 16% over two years in the composite endpoint of all-cause
mortality, myocardial infarction, documented unstable angina requiring
re-hospitalization, revascularization (performed at least 30 days after
randomization), and stroke among patients with the acute coronary
syndrome (ACS).8 Additionally, the Intensive Lipid
Lowering with Atorvastatin in Patients with Stable Coronary Disease
(TNT) trial that compared atorvastatin 80mg to 10mg showed a risk
reduction of 22% over 4.9 years in a major adverse cardiovascular event
(MACE), defined as cardiovascular death, non-fatal myocardial
infarction, resuscitation after cardiac arrest, and fatal or non-fatal
stroke.9 Similarly, in the Effects of Atorvastatin on
Early Recurrent Ischemic Events in Acute Coronary Syndrome (MIRACL)
trial, the early use of atorvastatin 80mg after ACS compared to placebo
had resulted in a 16% significant reduction in a primary composite
outcome of mortality, non-fatal myocardial infarction, and cardiac
arrest with resuscitation over a follow-up period of 16
weeks.10
Therefore, the use of atorvastatin 80mg among patients with coronary
artery disease (CAD) had resulted in a risk reduction of 16-22% in
MACE. However, to the best of our knowledge, the secondary prevention
cardiovascular benefit of atorvastatin 40mg compared to 80mg in the
setting of ACS has not yet been well-established. Although the CURE-ACS
trial compared both doses among ACS patients in terms of LDL-C
reduction11, there is no head-to-head comparison
between atorvastatin 40mg and 80mg to assess the cardiovascular
secondary prevention effect of the two regimens. Therefore, this
retrospective, observational cohort study aimed to compare using
real-world data the effectiveness and safety of two high-intensity
statin doses (atorvastatin 40mg vs. 80mg) in patients with ACS at 1
month and 12 months post-discharge, and to determine the predictors of
prescribing 80mg upon discharge.