Clinical implications of switching from intensive to moderate statin therapy after acute coronary syndromes

Background and aims: Intensive statin therapy represents an effective option after acute coronary syndromes (ACS). Despite evidence, switching to less effective statins frequently occurs in practice. Aim of this observational study was to assess the impact of switching from intensive to moderate statin therapy on clinical outcomes after ACS. Methods and results: A cohort of 1321 consecutive ACS patients (886 men, age 71 +/- 8 years) discharged on atorvastatin 80 mg/d in a 6.5 year period was followed for 12 months after discharge. During follow-up, 557 patients (42%) were switched by primary care physicians to moderate statin therapy, either for side effects (56%) or for safety concerns (44%). No major adverse reaction was reported. Increasing age (HR 1.52 per 10-year increase, 95% CI 1.23-1.78, p = 0.01), and female gender (HR 1.11, 95% CI 1.06-1.23, p = 0.02) were associated with a higher probability of switch. Patients following a cardiac rehabilitation program (HR 0.64 95% CI 0.49-0.86, p = 0.02) and diabetic subjects (HR 0.81, 95% CI 0.67-0.92, p = 0.02) were more likely to continue atorvastatin 80 mg/d. During follow-up, a major adverse clinical event occurred in 331 patients (one-year probability 025, 95% CI 0.22-027). Multivariate analysis with Cox proportional hazards method, including statin switching as a time-dependent covariate, demonstrated that, after adjustment for demographic and clinical variables, reduction from intensive to moderate statin therapy was an independent predictor of adverse clinical outcomes (HR 2.7, 95% CI 1.7-5.1, p = 0.004). Conclusion: Switching from intensive to moderate statin therapy after ACS is associated with an increased incidence of adverse clinical events. (C) 2010 Elsevier Ireland Ltd. All rights reserved.