Key result
Statin therapy linked to ~73% lower all-cause mortality in persistent smokers with CAD undergoing PCI.
Why the study?
The impact of statins on long-term outcomes in persistent tobacco users with stable CAD receiving PCI is poorly understood.
Does statin therapy reduce mortality and major adverse cardiovascular events in persistent tobacco users with stable CAD undergoing PCI?
Cohort (n=907)
No
Does statin therapy reduce mortality and major adverse cardiovascular events in persistent tobacco users with stable CAD undergoing PCI?
Effect estimate: HR 0.27 (95% CI 0.10-0.75)
In persistent smokers undergoing PCI, statin therapy is associated with reduced all-cause mortality, though smoking may attenuate its pleiotropic cardiovascular protective effects.
May support statin use in smokers post-PCI; hypothesis-generating and leaves open causality plus CV specificity.
The role of statins in improving cardiovascular outcomes is well established, but little is known about their impacts on long-term outcomes in persistent tobacco users with stable coronary artery disease (CAD) who receive percutaneous coronary intervention (PCI). A population of persistent smokers with CAD treated by PCI was analyzed. From 2012 through 2019, a cohort of 907 persistent tobacco users with stable CAD undergoing PCI were enrolled from the inpatient department of Taichung Tzu Chi Hospital, Taiwan. We surveyed statin users and non-statin users after index PCI, and general characteristics, major risk factors, angiographic findings, and long-term clinical outcome were compared. Kaplan-Meier curve was used to compare the survival difference and Cox proportional hazard model was used to analyze the predictors for all-cause mortality and major adverse cardiovascular events, including cardiovascular (CV) mortality, myocardial infarction, and repeated PCI procedures. The statin group had a higher average total cholesterol (P < .01) and low-density lipoprotein cholesterol (LDL-C) level (P < .01) and was younger (P < .01) than the non-statin group. Ninety-six point one percent patients in the statin group had a LDL-C level below 100 mg/dL after treatment. They also had a more frequent history of acute coronary syndrome and lower prevalence of chronic kidney disease than the non-statin group (both P < .01). Freedom from all-cause and CV mortality were lower in the non-statin group than the statin group (both P < .01). After adjustment for age and chronic kidney disease, statin treatment no longer reduced the risk of CV mortality (hazard ratio: 0.32, 95% confidence interval = 0.07-1.49), but was still associated with a reduction in all-cause mortality (hazard ratio: 0.27, 95% confidence interval = 0.10-0.75). In persistent tobacco users undergoing PCI, patients treated with statin for LDL-C values above 100 mg/dL had a similar level of cardiovascular protection as those with LDL-C below 100 mg/dL and without statin treatment. Therefore, smoking attenuates pleiotropic effect of statin. Nevertheless, statin therapy was still associated with a reduction of all-cause mortality.
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Lin et al. (2024) conducted a cohort in Stable coronary artery disease in persistent tobacco users (n=907). Statin vs. No statin was evaluated on All-cause mortality (HR 0.27, 95% CI 0.10-0.75). Statin therapy in persistent tobacco users with stable CAD undergoing PCI was associated with a reduction in all-cause mortality (HR 0.27; 95% CI 0.10-0.75), but not cardiovascular mortality.
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