Intensive-dose statin therapy reduces hospitalization rates in older Ontarians who have had a heart attack

A new study by scientists at the Institute for Clinical Evaluative Sciences (ICES) and Sunnybrook Health Sciences Centre in Toronto shows that intensive-dose statin therapy is effective in reducing repeat hospitalization for acute coronary syndrome (ACS) in older patients who have had a heart attack.

“While the overall benefit of statin therapy is clear in patients with heart attack, whether the efficacy of intensive-statin (high dosage) treatment is greater than what is seen with smaller doses is still uncertain,” says Dr. Dennis Ko, a scientist at ICES and an interventional cardiologist at the Schulich Heart Centre at Sunnybrook Health Sciences Centre. “But we found that intensive-dose statin therapy had superior efficacy in reducing repeat hospitalization for recurrent events,” he says.

About the study:

• Looked at 17,080 patients older than 65 years hospitalized with a myocardial infarction in Ontario from 2004 to 2010; 
• Compared patients prescribed intensive-dose versus moderate-dose statins at hospital discharge;
• Found the five-year rate of death (or ACS) was significantly lower at 44.8% in the intensive-dose statin group compared with 46.5% in the moderate-dose group.
• At five years, 13.6% of patients receiving intensive-dose statins and 13.0% of patients receiving moderate-dose statins had new-onset diabetes…

“I think this study provides evidence that shows intensive statins are underutilized in older patients,” says Ko.

“The five-year rate of death was significantly lower in the intensive-dose statin group compared with the moderate-dose group. This serves as a reassurance, and should encourage physicians to treat more often.” In this older group with previous heart attack the rate of new-onset diabetes was not significantly different between intensive-dose and moderate-dose statins. An increased risk of diabetes with high dose statin therapy has been found in other studies, including work done at ICES. In this study there was a small increase in risk but it did not reach statistical significance.

The study, “Diabetes and cardiovascular events in older myocardial infarction patients prescribed intensive-dose and moderate-dose statins” was published in the journal, Circulation Cardiovascular Quality and Outcomes.

Author block: Ko DT, Wijeysundera HC, Jackevicius CA, Yousef A, Wang J, Tu JV

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.