Background: Atherosclerotic cardiovascular disease (ASCVD) increases the risk of cardiovascular (CV) events. Although 2013 ACC/AHA guidelines recommend statin treatment, many patients remain untreated after a CV event.
Objective: To assess the impact of statin treatment on recurrent CV events in an integrated delivery network setting.
Methods: This retrospective study used insurance claims from Baylor Scott & White’s Virtual Data Warehouse. Eligible adults survived a hospitalization for a CV event (index event) from September 30, 2013, to September 30, 2014. CV event was defined as myocardial infarction, ischemic stroke, unstable angina, or coronary revascularization. Continuous enrollment 1 year pre-index was required; patients were followed up to 1 year. A Cox model was created to investigate the effect of post-index statin use on recurrent CV events as the primary outcome.
Results: These 1,260 patients had a median age of 74.8 [63.7, 83.2] years; 56.2% were male, 36.1% had type 2 diabetes, and 81.2% had hypertension. Coronary revascularization was the most common index event (368; 29.2%) and 79 (6.3%) individuals had at least 1 recurrent CV event during follow-up. The median time-to-event was 179 [98, 254] days, for patients who had 1 or more events following the index. CV events were independent of gender (p=0.71), age (p=0.44), and insurance (p= 0.95). Patients with a CV event in the year prior to the index were more likely to have another during follow-up (19.0% v. 9.2%, p = 0.005). Statin-treated patients increased from 531 (42.1%) to 759 (60.2%) following the index CV event (p < 0.001). Those who did not fill a statin prescription after the index had a 76% increased risk for a recurrent CV event within 1 year (hazard ratio: 1.76, 95% confidence interval: 1.13-2.74) compared to those who filled a statin prescription (Figure 1).
Conclusion: While statin use substantially increased after an index CV event, nearly 40% of patients remained untreated, increasing their recurrent CV event risk by 76%. Initiation and continuation of statin therapy after CV events remains a large public health opportunity for patients with ASCVD.