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Statins in elderly patients with acute coronary syndrome: an analysis of dose and class effects in typical practice
  1. Niteesh K Choudhry,
  2. Raisa Levin,
  3. Wolfgang C Winkelmayer
  1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to:
    Dr N K Choudhry
    Brigham and Women’s Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA; nchoudhry{at}


Objective: To compare the effectiveness of statins of different treatment intensity used to treat elderly patients with acute coronary syndrome (ACS) in typical care settings.

Design: Retrospective cohort study using linked hospital and pharmacy claims data.

Setting: Statewide pharmacy benefits programmes in Pennsylvania and New Jersey.

Participants: 18 311 Medicare patients discharged alive after ACS who received a prescription for a statin within 90 days of hospital discharge.

Main outcome measures: Using multivariable and propensity-matched Cox proportional hazards regression models, patients who were prescribed high-intensity and moderate-intensity statins were compared based on the drug–dose combination that they initially received. Individual drug–dose combinations were also compared. Our primary outcome was the composite of all-cause death or recurrent ACS.

Results: Patients who received moderate-intensity statins were as likely to experience a primary outcome as patients treated with high-intensity statins (adjusted HR 1.02, 95% CI 0.96 to 1.08). Propensity matching did not change the results. Individually, all moderate-intensity statins were as effective as high-intensity atorvastatin with the exception of lovastatin (adjusted HR 1.22, 95% CI 1.09 to 1.36). Similarly, all high-intensity statins seem as effective as high-intensity atorvastatin but the CIs surrounding these estimates were wide.

Conclusions: This analysis of elderly patients with ACS treated in typical care settings does not demonstrate the superiority of high-intensity over moderate-intensity statin treatment or significant differences among individual statins.

  • ACS, acute coronary syndrome
  • PAAD, Pharmaceutical Assistance to the Aged and Disabled
  • PACE, Pharmaceutical Assistance Contract for the Elderly
  • PROVE IT-TIMI 22, Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22

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  • Published Online First 19 February 2007

  • NKC had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests: We received no financial support for this research. NKC and RL receive salary support from Brigham and Women’s Hospital and do not have any financial arrangements with any other organisations or companies. WCW is recipient of a Scientist Development Grant from the American Heart Association and has received additional salary support through research grants from GlaxoSmithKline, Amgen and Astellas.

  • Contributors: NKC, RL, WCW contributed to the study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content and statistical expertise; NKC and RL analysed and interpreted the data; and NKC drafted the manuscript, provided administrative, technical or material support, and supervised the study.

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