J Med Assoc Thai 2015; 98 (2):129

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Achievement of LDL-Cholesterol Goal with Statins after an ST Segment Elevation Myocardial Infarction
Tungsubutra W Mail, Phongtuntakul B

Background: In patients with very high cardiovascular risk, low-density lipoprotein cholesterol (LDL-C) less than 70 mg/dL or at least 50% reduction of LDL-C are recommended targets. High-dose atorvastatin has been shown to reduce death and ischemic events among patients with acute coronary syndrome.

Objective: To evaluate the proportion of STEMI patients that achieve LDL-C goal after hospital discharge from a real-world setting in Thailand. To determine if the formulation of statin prescribed affected the LDL-C goal achievement.

Material and Method: The authors analyzed data from a cohort of patients with STEMI enrolled from June 1, 2008 through May 31, 2011. Patients who survived, were prescribed a statin on discharge and had LDL-C data at follow-up were analyzed. The formulation of statin was categorized as simvastatin or other statins (atorvastatin or rosuvastatin) group.

Results: Ninety-seven percent (n = 265 of 272) of patients were prescribed a statin at discharge. Of these, 216 patients had LDL-C data during a 3-month follow-up period, 75% were men, the mean age was 60.5±12.2 years old and the mean baseline LDL-C was 118.1±41.2 mg/dL. 73% (n = 157) of patients received simvastatin and 27% (n = 59) received other statins. At discharge, the median daily dose of simvastatin, atorvastatin and rosuvastatin were 20, 20 and 10 mg respectively. At follow-up, target LDL-C <70 mg/dL or LDL-C reduction ≥50% was achieved in 30.1% (n = 65) of patients, 27.4% (n = 43) on simvastatin and 37.3% (n = 22) on other statins, (p = 0.158, simvastatin versus other statins). When stratified by the dose intensity of statin, a significantly greater proportion of patients on moderate to high intensity statin attained LDL-C goals than those on low intensity statin: (36.3% versus 24.3%, p = 0.038).

Conclusion: Most patients with STEMI are prescribed statin therapy at discharge. Despite this, the target LDL-C is attained in a minority of the patients due to suboptimal statin dosing. The formulation of statin did not affect LDL-C goal attainment. High-dose statin therapy is underused in real-world clinical practice. These findings emphasize the opportunities to improve outcomes of STEMI patients with evidence-based therapies.

Keywords: Acute coronary syndrome, ST-segment elevation myocardial infarction, Statin, LDL-C

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