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Stronger Statin Use on the Rise in MI Patients

— Efforts to boost high-intensity statin prescriptions still needed

MedpageToday

Getting patients started on high-intensity statins after hospital discharge for an MI is becoming more popular, a study suggested, although the authors said more people could be on statins.

Among patients with commercial health insurance, the proportion of those who got a high-intensity statin prescription filled for secondary prevention after leaving the hospital was .

Similarly, that figure rose from 24.8% to 57.5% among Medicare patients, according to Robert S. Rosenson, MD, of Mount Sinai Heart in New York City, and colleagues.

"Despite this favorable trend, a substantial percentage of patients filled low- or moderate-intensity statin prescriptions following hospital discharge for MI in 2014. The present study highlights the need to continue efforts to increase high-intensity statin use following hospital discharge for MI," they wrote in the Journal of the American College of Cardiology.

Rosensen's group counted atorvastatin (Lipitor) and rosuvastatin (Crestor) as high-intensity statins. Atorvastatin was the only one of the two that showed an increase in popularity over the years; rosuvastatin actually lost prescription fills.

The reason, according to the authors: "In November 2011, the patent for atorvastatin expired, making this agent available in a generic version to some pharmacy benefit plans. By mid-2012, exclusive manufacturing rights expired, resulting in more widespread and less costly generic formulations of atorvastatin becoming available."

After multivariable adjustment, those more likely to get a high-intensity statin during the study period were men; those that also filled scripts for beta blockers and antiplatelets; and patients attending cardiac rehabilitation within 30 days of discharge.

Patients who got low- or moderate-intensity statins were more likely to get up-titrated to a stronger dose over time as well, their odds growing from 6.1% to 12.9% among commercial insurance patients and 3.7% to 9.2% among Medicare beneficiaries.

Besides the availability of generic atorvastatin, the authors pointed to the 2011 black-box warning by the FDA cautioning against 80 mg simvastatin (Zocor) as a potential reason for its decline, as well as American secondary prevention and cholesterol guidelines released in 2011 and 2013.

Their study took claims data from patients, ages 19-64, with commercial health insurance (n=42,893) and ages 66-75 covered under Medicare (n=75,096).

"An encouraging aspect of these new data for use of high-intensity statin from [the authors] suggests that clinicians do understand that not all high-intensity statin regimens have equivalent efficacy and safety," commented Neil J. Stone, MD, of Northwestern University Feinberg School of Medicine in Chicago.

In an , he found it "unclear why 80-mg simvastatin is still available." As for getting 100% of patients on strong statins, however, he placed great importance on clinical judgment on a case-by-case basis.

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    Nicole Lou is a reporter for 鶹ý, where she covers cardiology news and other developments in medicine.

Disclosures

The study was funded by Amgen, the University of Alabama at Birmingham, and the Icahn School of Medicine at Mount Sinai.

Rosenson disclosed relevant relationships with Akcea, Amgen, AstraZeneca, Eli Lilly, Esperion, The Medicines Company, Sanofi, Regeneron, and UpToDate. Co-authors disclosed multiple relevant relationships with industry.

Stone disclosed no relevant relationships with industry.

Primary Source

Journal of the American College of Cardiology

Rosenson RS, et al "Trends in use of high-intensity statin therapy after myocardial infarction, 2011 to 2014" J Am Coll Cardiol 2017; DOI: 10.1016/j.jacc.2017.03.585.

Secondary Source

Journal of the American College of Cardiology

Stone NJ "Statins in secondary prevention: intensity matters" J Am Coll Cardiol 2017; DOI: 10.1016/j.jacc.2017.04.018.