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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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