Key Points
- To identify clinical predictors of high-potency statin nonuse both early and late after an acute coronary syndrome.
- Secondary analysis of the randomized SOLID-TIMI 52 trial (NCT01000727), which enrolled 12,446 patients post-acute coronary syndrome across 36 countries between 2009 and 2011.
- High-potency statin therapy was defined as ≥40 mg atorvastatin, ≥20 mg rosuvastatin, or 80 mg simvastatin daily, with selection determined by treating physicians.
- Multivariable logistic regression evaluated clinical predictors of nonuse at baseline (median 14 days) and during long-term follow-up (median 2.3 years).
- While 95.2% of patients (11,850/12,446) were treated with a statin at baseline, only 41.9% (5,212/12,446) received a high-potency statin.
- Independent baseline predictors of nonuse included age ≥75 years (OR 1.39, 95% CI 1.24–1.56), female sex (OR 1.11, 95% CI 1.02–1.22), renal dysfunction (OR 1.17, 95% CI 1.03–1.32), and in-hospital heart failure (OR 1.43, 95% CI 1.27–1.62).
- At 3 months, 49% achieved LDL cholesterol <70 mg/dL, and lower LDL cholesterol among nonusers at 3 months predicted ongoing nonuse at median 2.3 years (OR 1.15 per 10 mg/dL decrease, 95% CI 1.11–1.19).
Structured PICO
PPopulation12,446 patients after an acute coronary syndrome enrolled in the SOLID-TIMI 52 trial across 36 countries
IInterventionHigh-potency statin (≥40 mg atorvastatin, ≥20 mg rosuvastatin, or 80 mg simvastatin daily)
CComparatorNonuse of high-potency statin
OOutcomePredictors of nonuse of high-potency statins
Despite widespread statin use after acute coronary syndromes, high-potency statins remain underutilized, particularly in older patients, women, and those with renal dysfunction or heart failure.