Factors Associated with Recurrent Coronary Events Among Patients with Cardiovascular Disease

Study Objective. To determine which factors are associated with recurrent coronary events. Design. Matched, case‐control study. Data Source. Electronic databases of a health maintenance organization. Patients. Of a cohort of adults (mean age 62 yrs, 68% male) who had an incident coronary event, defined as acute myocardial infarction or percutaneous coronary intervention, between January 1, 1999, and June 30, 2004, who survived and who were enrolled in a cardiac risk reduction service within 90 days after the incident event, 259 cases (patients who had a recurrent event between 90 days after the incident event and December 31, 2005) were matched with 688 controls (patients who did not have a recurrent event within this time frame). Measurements and Main Results. Multivariate conditional logistic regression was used to identify predictors of a recurrent coronary event. Although classic cardiac risk factors and drug therapies were similar for both groups at the time of the incident event, the mean low‐density lipoprotein cholesterol (LDL) level, non‐high‐density lipoprotein cholesterol (non‐HDL) level, and LDL:HDL ratio were higher and HDL levels were lower in the case patients compared with control patients (p<0.001) at the time of the case patients' recurrent events. More case patients received a statin but at a lower dose, defined as less than 40 mg of simvastatin equivalent (cases 45% vs controls 31%, p<0.001). Factors associated with a recurrent event included higher chronic disease score (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.0–1.2), higher LDL:HDL ratio (OR 2.2, 95% CI 1.5‐3.3), and statin dose less than 40‐mg simvastatin equivalent (OR 2.9, 95% CI 1.8‐4.9). Conclusion. These results support use of a statin at moderate‐to‐high doses as the basis of therapy for secondary coronary event prevention. The LDL:HDL ratio may help determine the degree of LDL lowering beyond traditional treatment goals.