Abstract

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

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

Setting Statewide pharmacy benefits programs 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, we compared patients who were prescribed high-intensity and moderate-intensity statins based on the drug-dose combination they initially received. We also compared individual drug-dose combinations. Our primary outcome was the composite of all-cause death or recurrent ACS.

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

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