Statin Treatment Intensity, Discontinuation, and Long-Term Outcome in Patients with Acute Myocardial Infarction and Impaired Kidney Function
(2023) In Journal of Cardiovascular Pharmacology 81(6). p.400-410- Abstract
Statin dosage in patients with acute myocardial infarction (AMI) and concomitant kidney dysfunction is a clinical dilemma. We studied discontinuation during the first year after an AMI and long-term outcome in patients receiving high versus low-moderate intensity statin treatment, in relation to kidney function. For the intention-to-treat analysis (ITT-A), we included all patients admitted to Swedish coronary care units for a first AMI between 2005 and 2016 that survived in-hospital, had known creatinine, and initiated statin therapy (N = 112,727). High intensity was initiated in 38.7% and low-moderate in 61.3%. In patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, 25% discontinued treatment the... (More)
Statin dosage in patients with acute myocardial infarction (AMI) and concomitant kidney dysfunction is a clinical dilemma. We studied discontinuation during the first year after an AMI and long-term outcome in patients receiving high versus low-moderate intensity statin treatment, in relation to kidney function. For the intention-to-treat analysis (ITT-A), we included all patients admitted to Swedish coronary care units for a first AMI between 2005 and 2016 that survived in-hospital, had known creatinine, and initiated statin therapy (N = 112,727). High intensity was initiated in 38.7% and low-moderate in 61.3%. In patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, 25% discontinued treatment the first year; however, the discontinuation rate was similar regardless of the statin intensity. After excluding patients who died, changed therapy, or were nonadherent during the first year, 84,705 remained for the on-treatment analysis (OT-A). Patients were followed for 12.6 (median 5.6) years. In patients with eGFR 30-59 mL/min, high-intensity statin was associated with lower risk for the composite death, reinfarction, or stroke both in ITT-A (hazard ratio [HR] 0.93; 95% confidence interval, 0.87-0.99) and OT-A (HR 0.90; 0.83-0.99); the interaction test for OT-A indicated no heterogeneity for the eGFR < 60 mL/min group (P = 0.46). Similar associations were seen for all-cause mortality. We confirm that high-intensity statin treatment is associated with improved long-term outcome after AMI in patients with reduced kidney function. Most patients with reduced kidney function initiated on high-intensity statins are persistent after 1 year and equally persistent as patients initiated on low-moderate intensity.
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- author
- Khedri, Masih ; Szummer, Karolina ; Lundman, Pia ; Jernberg, Tomas ; Desta, Liyew ; Lindahl, Bertil ; Erlinge, David LU ; Jacobson, Stefan H. and Spaak, Jonas
- organization
- publishing date
- 2023-06
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- acute myocardial infarction, chronic kidney disease, mortality, reinfarction, statin intensity, stroke
- in
- Journal of Cardiovascular Pharmacology
- volume
- 81
- issue
- 6
- pages
- 11 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:85161916608
- pmid:36735336
- ISSN
- 0160-2446
- DOI
- 10.1097/FJC.0000000000001402
- language
- English
- LU publication?
- yes
- id
- c77a387f-c8d9-4d05-bc0d-7f79882e4144
- date added to LUP
- 2023-09-15 11:10:33
- date last changed
- 2024-08-10 13:29:40
@article{c77a387f-c8d9-4d05-bc0d-7f79882e4144, abstract = {{<p>Statin dosage in patients with acute myocardial infarction (AMI) and concomitant kidney dysfunction is a clinical dilemma. We studied discontinuation during the first year after an AMI and long-term outcome in patients receiving high versus low-moderate intensity statin treatment, in relation to kidney function. For the intention-to-treat analysis (ITT-A), we included all patients admitted to Swedish coronary care units for a first AMI between 2005 and 2016 that survived in-hospital, had known creatinine, and initiated statin therapy (N = 112,727). High intensity was initiated in 38.7% and low-moderate in 61.3%. In patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m<sup>2</sup>, 25% discontinued treatment the first year; however, the discontinuation rate was similar regardless of the statin intensity. After excluding patients who died, changed therapy, or were nonadherent during the first year, 84,705 remained for the on-treatment analysis (OT-A). Patients were followed for 12.6 (median 5.6) years. In patients with eGFR 30-59 mL/min, high-intensity statin was associated with lower risk for the composite death, reinfarction, or stroke both in ITT-A (hazard ratio [HR] 0.93; 95% confidence interval, 0.87-0.99) and OT-A (HR 0.90; 0.83-0.99); the interaction test for OT-A indicated no heterogeneity for the eGFR < 60 mL/min group (P = 0.46). Similar associations were seen for all-cause mortality. We confirm that high-intensity statin treatment is associated with improved long-term outcome after AMI in patients with reduced kidney function. Most patients with reduced kidney function initiated on high-intensity statins are persistent after 1 year and equally persistent as patients initiated on low-moderate intensity.</p>}}, author = {{Khedri, Masih and Szummer, Karolina and Lundman, Pia and Jernberg, Tomas and Desta, Liyew and Lindahl, Bertil and Erlinge, David and Jacobson, Stefan H. and Spaak, Jonas}}, issn = {{0160-2446}}, keywords = {{acute myocardial infarction; chronic kidney disease; mortality; reinfarction; statin intensity; stroke}}, language = {{eng}}, number = {{6}}, pages = {{400--410}}, publisher = {{Lippincott Williams & Wilkins}}, series = {{Journal of Cardiovascular Pharmacology}}, title = {{Statin Treatment Intensity, Discontinuation, and Long-Term Outcome in Patients with Acute Myocardial Infarction and Impaired Kidney Function}}, url = {{http://dx.doi.org/10.1097/FJC.0000000000001402}}, doi = {{10.1097/FJC.0000000000001402}}, volume = {{81}}, year = {{2023}}, }