Falling cholesterol trend at acute coronary syndrome presentation is strongly related to statin use for secondary prevention

Thomas Chan; Bilyana Dabin; Karice Hyun; Isuru Ranasinghe; Lis Neubeck; Bernadette Aliprandi-Costa; Jeffrey Lefkovits; Gerard Devlin; Craig Juergens; Derek P Chew; David Brieger; S Ben Freedman

doi:10.1016/j.ijcard.2016.03.038

Falling cholesterol trend at acute coronary syndrome presentation is strongly related to statin use for secondary prevention

Int J Cardiol. 2016 Jun 1:212:192-7. doi: 10.1016/j.ijcard.2016.03.038. Epub 2016 Mar 16.

Authors

Affiliations

¹ University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia.
² University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia; The George Institute of Global Health, University of Sydney, Sydney, Australia.
³ Discipline of Medicine, University of Adelaide, Adelaide, Australia.
⁴ Sydney Nursing School, University of Sydney, Sydney, Australia.
⁵ Royal Melbourne Hospital, Melbourne, Australia.
⁶ Waikato Clinical School, University of Auckland, Auckland, New Zealand.
⁷ Liverpool Hospital, Southwestern Sydney Clinical School, University of New South Wales, Sydney, Australia.
⁸ Flinders University, Southern Adelaide Local Health Network, Department of Cardiovascular Medicine, Adelaide, Australia.
⁹ University of Sydney, Sydney Medical School, Concord Hospital, Dept. of Cardiology, Sydney, Australia; Anzac Research Institute, University of Sydney, Concord Hospital, Sydney, Australia; Heart Research Institute, Charles Perkins Centre, University of Sydney, Australia. Electronic address: ben.freedman@sydney.edu.au.

PMID: 27038732
DOI: 10.1016/j.ijcard.2016.03.038

Abstract

Background: Lifestyle changes are believed responsible for temporal trends of reduced population total cholesterol (TC), but it is uncertain whether this applies to patients with known coronary heart disease (CHD) often prescribed lipid lowering therapy (LLT). We studied temporal TC trends at presentation with acute coronary syndrome (ACS) to determine the contribution of LLT given for secondary prevention.

Methods: TC and LLT were obtained in 5592 patients in annual surveys of ACS admissions in Australia between 1999 and 2013, and annual mean trends analysed by linear and segmented regression.

Results: TC declined from 5.13±1.1 to 4.53±1.2mmol/L (p<0.001) and LLT (96% statin) use at presentation increased from 37.4% to 47.5% (p=0.005). TC decline was greater in those on LLT vs. those not on therapy, with LLT contributing to 57% of the TC decline. The decline in TC and increase in LLT use was non-linear and much steeper in those with, than without CHD history, and LLT contributed substantially more to the TC decline (79%, p<0.001 vs. 27%, p=0.06 respectively). The rapid decline in TC and increase in LLT, plateauing after 2005 in those with CHD history differed markedly from trends in recent population studies, while TC trend for those without CHD history was slower, linear and consistent with population trends.

Conclusions: Declining TC level at presentation for ACS was strongly associated with increasing LLT use in those with a history of CHD, indicating that increasing uptake of LLT for secondary prevention has impacted TC changes in the new millennium.

Keywords: Acute coronary syndrome; Cholesterol; Statin therapy; Temporal trend.

Publication types

Multicenter Study

MeSH terms

Acute Coronary Syndrome / blood*
Acute Coronary Syndrome / drug therapy*
Acute Coronary Syndrome / epidemiology
Aged
Australia / epidemiology
Cholesterol / blood*
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Male
Middle Aged
Observational Studies as Topic
Prospective Studies
Registries
Secondary Prevention
Treatment Outcome

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cholesterol