Abstract 17323: Personalizing Cholesterol Management Therapy Using Electronic Medical Records and Machine Learning

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Andrew T Ward ◽  
Jiang Li ◽  
Ashish Sarraju ◽  
Areli Valencia ◽  
David Scheinker ◽  
...  
Keyword(s):  
Machine Learning ◽  
Statin Therapy ◽  
High Intensity ◽  
Treatment Decisions ◽  
Moderate Intensity ◽  
Study Cohort ◽  
Low Intensity ◽  
One Year ◽  
Statin Use

Introduction: Optimal statin treatment decisions for primary prevention of atherosclerotic cardiovascular disease (ASCVD) rely on shared decision-making between patient and provider. We sought to develop a machine learning-based algorithm to personalize cholesterol treatment decisions using electronic medical record (EMR) data. Methods: We included EMR data for adults aged 40 to 79 with no prior ASCVD or statin therapy from an outpatient Northern California system between January 1, 2009 and December 31, 2018 with at least two visits at least 1 year apart and at least two low density lipoprotein cholesterol (LDL-C) values. The outcome was the LDL-C measured closest to one year after a patient’s second visit. We modeled four different treatment decisions: no statin use, low-intensity statin use, moderate-intensity statin use, and high-intensity statin use. We trained weighted-K-nearest-neighbor (wKNN) regression models to identify similar patients using each line of therapy to a candidate patient. The algorithm compared outcomes of these similar patients and recommended the treatment which predicted the lowest LDL-C after one year. Results: Our study cohort consisted of 50,911 patients (age 54.6 ± 9.84 years, baseline LDL-C 122 ± 34.2 mg/dL, follow-up LDL-C 121 ± 35.9 mg/dL) including 54% female, 47% Non-Hispanic White, 32% Asian, and 7.5% Hispanic patients. Among 8,551 test patients visiting in 2015 or later, 96.9%, 3.08%, and 0.05% were recommended to begin high-intensity, moderate-intensity, and low-intensity statins, respectively. With these recommendations, the LDL-C values at 1-year follow-up were predicted to be 21.5 ± 43.5 mg/dL (17.6%) lower per patient, on average (Figure). Conclusions: EMR-trained wKNN models are able to determine patient LDL-C trajectories under different lines of statin therapy. Machine learning models leveraging real-world datasets may provide useful statin therapy treatment recommendations for primary ASCVD prevention.

Abstract 9: Post-Discharge Use of Statin and Lipid Testing After Myocardial Infarction

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
William T Wang ◽  
Anne Hellkamp ◽  
Jacob Doll ◽  
Laine Thomas ◽  
Anne M Navar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Statin Therapy ◽  
High Intensity ◽  
Moderate Intensity ◽  
Post Discharge ◽  
Cardiovascular Risk Reduction ◽  
Lipid Testing ◽  
Cholesterol Guidelines ◽  
Statin Use

Background: The 2013 ACC/AHA cholesterol guidelines recommend high intensity statin use for all post-myocardial infarction (MI) patients, instead of treating to a low density lipoprotein cholesterol (LDL-C) goal on follow-up lipid testing. We examined whether high intensity statin use was common in U.S. practice prior to these guideline updates. Methods: We linked the ACTION Registry-GWTG to Medicare data and evaluated 11,046 post-MI patients aged ≥65 years discharged alive on a statin from 347 hospitals between 2007 and 2009. Rates and dosing of lipid therapy as well as follow-up lipid testing within 90 days after discharge were studied. Multivariable logistic regression was used to evaluate the association of lipid testing with 1-year statin use and intensity. Results: Only 21% of MI patients were discharged on a high intensity statin. By 90 days post-MI, 44% (n=4,884) of patients underwent lipid testing. Among patients discharged on low/moderate intensity statins, 43% underwent lipid testing within the next 90 days, and 49% of patients discharged on high intensity statins received lipid testing within 90 days. Rates of lipid testing did not differ substantially between patients with LDL-C ≥100 mg/dL vs. <100 mg/dL during the MI hospitalization (47% vs. 43%). Among MI patients alive at 1 year, 74% remained on a statin, yet only 14% were on a high intensity statin. Only 4% of those discharged on low/moderate dose statin had been titrated up to a high intensity statin. Patients undergoing lipid testing within 90 days of discharge were more likely to be on a statin at 1 year (Figure, adjusted OR 1.17, 95% CI 1.07-1.29), and more likely to have their statin therapy intensified (adjusted OR 1.92%, 95% CI 1.52-2.41). Conclusion: Prior to the 2013 ACC/AHA cholesterol guideline updates, only 1 in 5 MI patients were discharged on high intensity statin therapy. Although follow-up lipid testing was associated with both higher rates of statin persistence to one year and increased likelihood of statin intensification, it was performed in only a minority of patients. The new cholesterol guidelines may promote more aggressive lipid management and cardiovascular risk reduction by eliminating treatment dependence on follow-up lipid testing.

scholarly journals Evaluation of LDL goal achievement in statin consumption, south east of Iran

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malihe Aghasizadeh ◽  
Saeede Khosravi Bizhaem ◽  
Mahin Baniasadi ◽  
Mohammad Reza Khazdair ◽  
Toba Kazemi
Keyword(s):  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Goal Achievement ◽  
Moderate Intensity ◽  
Cvd Risk ◽  
Intensity Pattern ◽  
Cross Sectional ◽  
Low Intensity ◽  
Very High ◽  
Statin Use

AbstractLipid goal achievement and statin consumption were estimated at extreme/very-high/high/moderate and low cardiovascular risk categories. In the cross-sectional study, 585 patients treated with statin therapy referring to the heart clinic of Birjand were recruited. Patients were classified and examined LDL-C values and the proportion reaching targets according to the American Association of Clinical Endocrinologists guideline. Three patterns of statin use (high/moderate/low-intensity statin therapy) in all patients were examined and attainments of LDL-C goal in cardiovascular risk groups have been demonstrated. Over half the populations (57.6%) were in the very-high CVD risk group. The results showed that the proportion of patients meeting total LDL-C goal values according to the guidelines was 43.4%. The frequency of patient had achievement LDL goal lower in high-intensity pattern (N = 13, 2.3%), compared with moderate (N = 496, 86.1%) and low-intensity patterns (N = 67, 11.6%). In general, LDL-C goal achievement was greatest with moderate-intensity statin use. LDL-C reduction after statin consumption was estimated about one-third of the studied population. It seems likely that the achievement of a therapeutic target for serum lipids such as LDL-C improved is far more cost-effective and would be able to reach the target LDL as well changing the type and intensity of statins.

P641Patient characteristics and treatment patterns in patients on lipid-lowering therapies following an acute coronary syndrome in France

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Bruckert ◽  
G Desamericq ◽  
A Khachatryan ◽  
P Ngo ◽  
G Gusto ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Intensity ◽  
Density Lipoprotein ◽  
Treatment Patterns ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Treatment Intensity ◽  
Coronary Syndrome ◽  
Low Intensity

Abstract Background introduction Many patients, especially those at very high cardiovascular (CV) risk, do not reach low-density lipoprotein cholesterol (LDL-C) targets for at least 2 reasons: they may not receive a sufficiently intensive regimen, and/or they may not adhere to their medication. Purpose Describe demographic, clinical characteristics and treatment intensity and adherence in patients on lipid lowering therapies (LLT) following an Acute Coronary Syndrome (ACS) in France. Methods Retrospective cohort study on the PGRx (the Pharmacoepidemiologic General Research eXtension program)-ACS dataset in France, with data collected retrospective and prospectively via physicians, prescription records and patient interviews. Patients were accrued prospectively and/or retrospectively by centres from the PGRx Cardiology and General Practitioners networks. We included adult patients (≥18 years) suffering an ACS between 2013 and 2016 who received LLT at or within 92 days of their ACS hospital discharge. Follow-up was censored at time of new CV event, death, lost to follow-up or interview date (mean duration 12.4 months). Outcomes of interest included LLT intensity (high, moderate and low intensity statins with or without ezetimibe) and adherence measured as proportion of days covered (PDC). Results 2695 eligible patients were included (77% men); mean age (SD) 63.1 (12.8), 18% had diabetes mellitus, mean (SD) LDL-C 112.1 (46.4) mg/dl. Treatment with LLT at discharge is summarised in table below. Age and baseline LDL-C were drivers of treatment intensity with higher proportion of patients on high intensity statins in younger patients and in those with higher baseline LDL-C. Overall 70% of patients were adherent (PDC≥80%). Patients on moderate intensity were more adherent (76%) than those on low (63%) or high intensity statins (67%). Treatment patterns with LLT after an ACS LLT following ACS N (%) PDC at 1 year, Mean (SD) Adherent, N (%) Not Adherent, N (%) Ezetimibe 34 (1.3%) 82.8% (31.3%) 26 (76.5%) 8 (23.5%) Low intensity statins 64 (2.4%) 74.8% (33.8%) 40 (62.5%) 24 (37.5%) Moderate intensity statins 993 (37.1%) 82.0% (30.9%) 751 (75.6%) 242 (24.4%) High intensity statins 1515 (56.6%) 74.6% (36.2%) 1007 (66.5%) 508 (33.5%) Statin + ezetimibe 59 (2.2%) 75.9% (34.7%) 40 (67.8%) 19 (32.2%) Overall 2695 (100%) 77.6% (34.3%) 1871 (69.9%) 807 (30.1%) Conclusion(s) Our data show a substantial proportion of patients in France are not treated with high intensity statins after an ACS despite guidelines recommendation. Adherence to LLT is acceptable in patients after an ACS although it appears to worsen when high intense statins are used Acknowledgement/Funding Study has been funded by Amgen GmbH

Abstract 195: Statin Use and Its Facility Level Variation in Patients With Ischemic Cerebrovascular Disease: Insights From the Department of Veterans Affairs

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cameron L McBride ◽  
Julia Akaroyd ◽  
David J Ramsey ◽  
Vijay Nambi ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Statin Therapy ◽  
High Intensity ◽  
Veterans Affairs ◽  
Prescribing Patterns ◽  
Moderate Intensity ◽  
Level Variation ◽  
Ischemic Cerebrovascular Disease ◽  
Facility Level ◽  
Statin Use

Background: The 2013 ACC/AHA cholesterol guideline recommends high-intensity statin therapy in patients 75 or younger and moderate-intensity statins in patients > 75 years with atherosclerotic cardiovascular disease including those with ischemic cerebrovascular disease (ICVD). Statin prescribing patterns and their facility-level variation in patients with ICVD are unknown. Methods: We examined the frequency and facility-level variation in the use of any and correct intensity statins in patients with ICVD (ischemic stroke or carotid arterial disease) who received primary care in 130 facilities across the Veterans Affairs (VA) health care system with or without concomitant ischemic heart disease (IHD) or peripheral artery disease (PAD). We then calculated median rate ratios (MRR) adjusted for patient demographic factors to assess the magnitude of facility-level variation in statin prescribing patterns for comparable patients. Results: Among 339,771 ICVD patients, 182,231 (53.6%) had ICVD without IHD (with or without PAD) and 163,730 (48.2%) had ICVD without IHD or PAD. Rates of statin use in the entire ICVD group, patients with ICVD without IHD, and ICVD alone were 78.1%, 70.9% and 69.9%, respectively. Median facility-level rates of any statin use were 78.1% (IQR 75.5-80.7), 70.7% (67.9-73.8) and 69.9% (66.9-73.1), respectively. Correct intensity statins were prescribed among 40.2% of the entire ICVD group, 30.5% with ICVD without IHD, and 29.6% with ICVD alone. Median facility-level rate of correct statin use in all ICVD patients was 39.1% (35.8-43.9), 29.9% (26.0-34.6) for patients with ICVD without IHD and 29.0% (25.4-33.7) in those with ICVD alone.Calculated MRRs reflect approximately 22% variation among two facilities treating two identical ICVD patients with statin therapy and a 27-28% variation in identical ICVD patients for correct statin intensity (Table). Conclusions: The use of statin and especially guideline-recommended statin intensity is suboptimal in ICVD patients, especially patients without concomitant IHD or PAD. There is significant facility-level variation in receipt of guideline directed statin therapy in ICVD patients. Interventions are needed to improve guideline directed moderate to high-intensity statin use and reduce variation in care in this high risk group.

Abstract P194: LDL-Cholesterol Reduction and Efficacy of Statin Intensity Over One Year in Veterans With the Familial Hypercholesterolemia Phenotype

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Saadia Qazi ◽  
Laura M Tarko ◽  
Yuk-Lam Ho ◽  
Senthil Selvaraj ◽  
Hyun J Shin ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Kidney Disease ◽  
Statin Therapy ◽  
High Intensity ◽  
Regression Models ◽  
Ldl Cholesterol ◽  
Moderate Intensity ◽  
Logistic Regression Models ◽  
Adjusted Logistic Regression ◽  
One Year

Introduction: Severe elevations of LDL-Cholesterol (LDL-C) ≥190mg/dl in adults, representing the familial hypercholesterolemia (FH) phenotype, have been associated with increased risk of cardiovascular disease (CVD). The 2013 AHA/ACC guidelines recommend high intensity statin therapy to reduce LDL-C by ≥50%. We identified patients with FH phenotype in the Veterans Health Administration (VHA) who were statin-naive and determined the degree of LDL-C reduction over one year after statin initiation and the efficacy of statin intensity on ≥50% reduction. Methods: Patients receiving care at the VHA from 2002-2007, ≥21 years of age, with baseline LDL-C measurement of ≥190 mg/dl (LDL-C 0 ), and statin-naïve were included. Statin initiation was required within 90 days of LDL-C 0 , and a follow up level (LDL-C 1 ) had to be collected within one year ± 90 days. All participants were free of clinical CVD at baseline. Baseline characteristics were ascertained from patient charts. LDL-C reduction was defined as the difference between LDL-C 0 and LDL-C 1 . Multivariable logistic regression models, adjusted for age, sex, race, diabetes, kidney disease, hypertension, and hypertension treatment were constructed to determine the odds of goal LDL-C (≥50%) reduction by statin intensity. We defined statin intensity per the 2013 AHA/ACC guidelines. High intensity statins included Simvastatin 80mg, Atorvastatin 40-80mg, and Rosuvastatin 20-40mg. Results: We included 35,894 Veterans (Men: N= 33,049 (92.1%), Age=55±10 years; Women: N=2845 (7.9%), Age=50±11 years). The mean duration between LDL-C 0 and LDL-C 1 was 52±7 weeks. The population was predominantly white (78.1%). Mean LDL-C 0 was 210±22 mg/dl, triglycerides were 175±126 mg/dl. At baseline, 0.3% had kidney disease, 14.1% diabetes, and 52.8% hypertension. Mean absolute LDL-C reduction in the population was 70.2±41.9 mg/dl. A total of 6718 (18.7%) patients achieved an LDL-C reduction of ≥50%. Among these patients, 5.2% were on low, 62.2% were on moderate, and 32.6% were on high intensity statins. In multivariable-adjusted logistic regression models using moderate intensity statins as the comparator, high intensity therapy resulted in 97% higher odds of achieving goal LDL-C reduction (Odds ratio [OR]=1.97; 95% Confidence Interval [CI]=1.85-2.09), and low intensity statins resulted in 42% lower odds of achieving goal LDL-C reduction (OR= 0.58; 95%CI= 0.52-0.65). Conclusions: In a large veteran population with the FH phenotype, though there was a marked reduction in LDL-C with statin therapy, most patients did not achieve goal LDL-C reduction of ≥50%. This may be related to statin intensity, individual response to statin therapy, or lack of adherence to treatment. In multivariable-adjusted logistic regression models, patients on high intensity statins had 2-fold odds of goal LDL-C reduction compared to moderate intensity statins.

Effects of High Intensity Statin Therapy in the Treatment of Diabetic Dyslipidemia in Patients with Coronary Artery Disease

2018 ◽  
Vol 24 (4) ◽  
pp. 427-441 ◽  
Author(s):  
Marija Vavlukis ◽  
Sasko Kedev
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
Statistical Significance ◽  
Incident Diabetes ◽  
Moderate Intensity ◽  
Protective Effects ◽  
Pcsk9 Inhibitors ◽  
Diabetic Dyslipidemia ◽  
Patients With Diabetes

Background: Diabetic dyslipidemia has specifics that differ from dyslipidemia in patients without diabetes, which contributes to accelerated atherosclerosis equally as dysglycemia. The aim of this study was to deduce the interdependence of diabetic dyslipidemia and cardiovascular diseases (CVD), therapeutic strategies and the risk of diabetes development with statin therapy. Method: We conducted a literature review of English articles through PubMed, PubMed Central and Cochrane, on the role of diabetic dyslipidemia in atherosclerosis, the antilipemic treatment with statins, and the role of statin therapy in newly developed diabetes, by using key words: atherosclerosis, diabetes mellitus, diabetic dyslipidemia, CVD, statins, nicotinic acid, fibrates, PCSK9 inhibitors. Results: hyperglycemia and dyslipidemia cannot be treated separately in patients with diabetes. It seems that dyslipidemia plays one of the key roles in the development of atherosclerosis. High levels of TG, decreased levels of HDL-C and increased levels of small dense LDL- C particles in the systemic circulation are the most specific attributes of diabetic dyslipidemia, all of which originate from an inflated flux of free fatty acids occurring due to the preceding resistance to insulin, and exacerbated by elevated levels of inflammatory adipokines. Statins are a fundamental treatment for diabetic dyslipidemia, both for dyslipidemia and for CVD prevention. The use of statin treatment with high intensity is endorsed for all diabetes-and-CVD patients, while a moderate - intensity treatment can be applied to patients with diabetes, having additional risk factors for CVD. Statins alone are thought to possess a small, although of statistical significance, risk of incident diabetes, outweighed by their benefits. Conclusion: As important as hyperglycemia and glycoregulation are in CVD development in patients with diabetes, diabetic dyslipidemia plays an even more important role. Statins remain the cornerstone of antilipemic treatment in diabetic dyslipidemia, and their protective effects in CVD progression overcome the risk of statin- associated incident diabetes.

Six-month outcomes of a high intensity exercise programme in young patients with hypertrophic cardiomyopathy: The SAFE-HCM trial

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Basu ◽  
S Jayakumar ◽  
C Miles ◽  
G Parry-Williams ◽  
H Maclachlan ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
High Intensity ◽  
Young Patients ◽  
Exercise Adherence ◽  
Exercise Programme ◽  
Exercise Group ◽  
Moderate Intensity ◽  
Psychological Benefits ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Cardiac Risk in the Young Background Moderate intensity exercise training in older patients with hypertrophic cardiomyopathy (HCM) can improve functional capacity, without significant harm. However, younger patients are attracted to high intensity training (HIT) regimes. The SAFE-HCM study demonstrated that an individually tailored, HIT programme in young patients with HCM was feasible, and provided both health and psychological benefits, without an increase in the burden of arrhythmia. Purpose To assess whether observed benefits of a HIT programme in young patients with HCM are sustained at 6 months. Methods Eighty patients with HCM (45.7y+/-8.6) underwent baseline clinical and psychological assessment. Individuals were randomised to a 12-week HIT programme (n = 40) or usual care (n = 40). Baseline evaluation was repeated at 12 weeks (T12). Feasibility, safety, health and psychological benefits were assessed. At 12-weeks individuals were encouraged to continue with the frequency and intensity of physical activity (PA) achieved at the end of the cardiac rehabilitation programme. Participants in the exercise arm were invited to follow-up at 6 months (T6m). Results The majority (83%) of participants completed the 12-week study. At T12 there was no significant difference between groups in the composite arrhythmia safety outcome (p = 0.99). The indices of exercise capacity were significantly improved in the exercise compared to the control group; peak VO2 (+3.7ml/kg/min [CI 1.1,6.3], p = 0.006), VO2/kg at anaerobic threshold (VO2/kgAT) (+2.44ml/kg/min [CI 0.6,4.2], p = 0.009), time to AT (+115s [CI 54.3,175.9], p &lt; 0.001) and exercise time (max ET) (+108s [CI 33.7,182.2], p = 0.005). The exercise group also demonstrated greater reduction in systolic BP (-7.3mmHg [CI -11.7,-2.8], p = 0.002), BMI (-0.8kg/m2 [CI-1.1,-0.4], p &lt; 0.001), anxiety (-2.6 [CI-3.6,-1.6], p= &lt;0.001) and depression (-1.1 [CI -2.0,-0.2], p = 0.015) scores. At T6m patient reported exercise adherence was comparable to baseline PA in 33/34 of the exercise group attending for follow up. Most exercise gains dissipated with the exception of time to AT (p = 0.002), max ET (p = 0.003), VO2/kgAT (p = 0.04) and anxiety score (p &lt; 0.001) (Figure 1). There were no sustained episodes of atrial or ventricular arrhythmias. The incidence of NSVT did not differ between time points (p = 0.09). Conclusion A 12-week HIT programme in young patients with HCM offers considerable gains in fitness and psychological outcomes, with no increase in arrhythmic burden. At T6m exercise levels as well as most physiological adaptations and health benefits returned to baseline, as seen in other studies when formal participation in an exercise programme comes to an end. This highlights the importance of the implementation of strategies to encourage ongoing engagement in PA. Potential solutions include identification of barriers to exercise, as well as adoption of novel tele-rehabilation approaches. Abstract Figure 1 Sustained benefits at T6m

Abstract 188: Hospital and Regional Variation in Use of High-intensity Statins Following Myocardial Infarction Among Medicare Beneficiaries

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Emily B Levitan ◽  
Paul Muntner ◽  
Yu Ling Dai ◽  
Mark Woodward ◽  
Matthew Mefford ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical School ◽  
High Intensity ◽  
Lower Percentage ◽  
Moderate Intensity ◽  
Medicare Beneficiaries ◽  
American Hospital ◽  
Hospital Size ◽  
School Affiliation ◽  
Statin Use

Background: American College of Cardiology/American Heart Association guidelines published in 2013 recommend high-intensity statins (atorvastatin 40 or 80 mg or rosuvastatin 20 or 40 mg) for most adults ≤75 years of age with atherosclerotic cardiovascular disease (ASCVD). For adults >75 years of age with ASCVD, the guidelines recommend continuation of tolerated statins or initiation of moderate intensity statins for most patients. Objective: To examine whether guideline concordant use of high-intensity statins following myocardial infarction (MI) among Medicare beneficiaries differed by hospital size, medical school affiliation, and region of the US in 2014 (after publication of the guidelines). Methods: We identified 28,086 Medicare beneficiaries with fee-for-service and pharmacy coverage who filled a statin within 30 days following hospital discharge for MI in 2014. The analyses were restricted to 731 hospitals with at least 20 beneficiaries discharged for MI in 2014. Hospital size and medical school affiliation were determined from the American Hospital Association survey. In subgroups ≤75 and >75 years of age, we calculated the proportion of beneficiaries whose first statin fill after MI was a high-intensity statin by hospital, hospital size, medical school affiliation, and region. Results: Among statin users ≤75 years of age, 10,696 (55%) beneficiaries filled a prescription for a high-intensity statin following MI. The percentage filling high-intensity statins range from 0-100% (25 th percentile 39%, 75 th percentile 69%) across hospitals. High-intensity statin use was more common following hospitalization at larger hospitals, hospitals with medical school affiliations, and those in New England ( Figure ). A lower percentage of Medicare beneficiaries >75 years of age filled high-intensity statins (n = 8,441, 44%), but patterns were similar across hospital characteristics and region. Conclusions: Similar patterns of high-intensity statin use were present among individuals ≤75 years of age, in whom high-intensity statin use is guideline concordant, and individuals >75 years of age, in whom high-intensity statin use is not necessarily guideline concordant, suggesting that variation in high-intensity statin prescriptions may not be directly related to close adherence to guidelines.

Abstract P118: Use of Statins and Antihypertensive Medications in Relation to Recurrence of Atrial Fibrillation and Progression to Permanent Atrial Fibrillation

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Evan L Thacker ◽  
Paul N Jensen ◽  
Bruce M Psaty ◽  
Barbara McKnight ◽  
W. T Longstreth ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ace Inhibitors ◽  
Beta Blockers ◽  
Medication Use ◽  
Hazard Ratios ◽  
One Year ◽  
Healthy User Bias ◽  
Statin Use

Objective. We sought to determine among people whose initial atrial fibrillation (AF) terminated whether use of statins, beta-blockers, and ACE inhibitors or ARBs was associated with lower risk of recurrent AF or progression to permanent AF. Methods. In Group Health, an integrated health care system, we identified an inception cohort of people aged 30-84 with newly diagnosed AF in 2001-2004 whose initial AF terminated within six months. Follow-up was through 2009. Medication use throughout follow-up was determined from the pharmacy database. Recurrent AF and permanent AF were determined from medical records and ECG and procedure code databases. Permanent AF was defined as AF present on two dates at least six months apart with no evidence of sinus rhythm in between. Cox proportional hazards models were used to estimate hazard ratios. We compared current statin use with nonuse. To reduce healthy user bias, we compared statin use one year prior with nonuse one year prior. To reduce confounding by indication, we compared beta-blocker use with nondihydropyridine calcium channel blocker use. We compared current ACE inhibitor or ARB use with nonuse. Results. Analyses included 1,511 people. Mean age was 70 years and 51% were men. Statins were used for 36% of person-time, beta-blockers for 48%, and ACE inhibitors or ARBs for 42%. Five-year cumulative incidence of recurrent AF was 74% and of permanent AF was 24%. Current statin use vs. nonuse was associated with lower permanent AF risk. However, statin use vs. nonuse one year prior was not associated with permanent AF ( Table ). Use of beta-blockers and ACE inhibitors or ARBs was not associated with recurrent AF or permanent AF. Adjusted hazard ratios of recurrent AF and permanent AF according to medication use. Medication use Recurrent AF Adjusted HR * (95% CI) Permanent AF Adjusted HR * (95% CI) Statins -- current use analysis Nonuse 1.00 (reference) 1.00 (reference) Current use 0.96 (0.82, 1.12) 0.76 (0.58, 0.99) Statins -- lagged analysis Nonuse one year prior 1.00 (reference) 1.00 (reference) Use one year prior 0.94 (0.79, 1.13) 0.98 (0.74, 1.30) Beta-blockers Current nondihydropyridine CCB use 1.00 (reference) 1.00 (reference) Current beta-blocker use 0.91 (0.74, 1.12) 1.04 (0.69, 1.56) ACE inhibitors or ARBs Nonuse 1.00 (reference) 1.00 (reference) Current use 0.99 (0.86, 1.14) 0.98 (0.77, 1.25) * Adjusted for age, sex, BMI, diabetes, hypertension, coronary heart disease, valvular heart disease, heart failure, prior stroke, and chronic kidney disease. Conclusion. The lagged statin analysis suggests that the association of current statin use with lower permanent AF risk may have been due to an acute effect of statins that did not persist after discontinuation of use, or to a healthy user bias. We found little evidence that use of statins, beta-blockers, or ACE inhibitors or ARBs reduces risk of recurrent AF or permanent AF.

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