Abstract 680: What Matters Most, Statin Intensity or Achieved LDL? - Evaluating Concordance of AHA/ACC Guidelines for Statin Use with Practice Outcomes at Stanford Hospital & Clinics
Introduction: Recommendations from the 2013 American College of Cardiology/American Heart Association Guidelines on the Assessment of Cardiovascular Risk have had a mixed reception. The goal of our study was to evaluate practice-based evidence from Stanford Hospital using structured and unstructured bioinformatics data to determine whether achieved LDL or statin intensity was more predictive of major adverse cardiac events (MACE).
Methods: We performed a retrospective cohort analysis of all adult patients >= 21 years of age prescribed statin therapy between 1996 and 2015. Demographic and clinical variables were extracted from coded data and unstructured clinical text using a validated data extraction pipeline. To account for possible treatment selection bias we performed 1:1 propensity score matching to produce a patient cohort with similar demographic, comorbid disease, and laboratory value distributions between treatment groups. Mcnemar’s Chi-squared and conditional logistic regression analyses were performed to identify variables predictive of MACE.
Results: We identified 7,378 adults on statin therapy with complete data. Patients were followed on average for 3.3 years, 56% percent were male, 55% were Caucasian, and mean age was 64 years. Patients had a high burden of comorbidities (85% with HTN, 64% with Type II Diabetes, 58% with CAD, 42% with CHF, and 32% with PAD). Patients on high-intensity statins were matched with those on low-/moderate-intensity statins, producing a cohort of 2,056 patients with equal distributions of comorbidities, co-prescriptions and LDL measurements. In this well-balanced cohort, statin intensity did not predict MACE (P=0.29) while achieved LDL was a significant predictor of outcomes (P=0.006). OR for MACE was 0.73 (95% CI 0.65-0.82) in patients with LDL of <=70 versus those with LDL >100. OR for MACE for LDL <=70 versus LDL >= 130 was 0.32 (95% CI 0.28-0.38).
Conclusions: Using a retrospective matched cohort design we found that achieved LDL was a significant predictor of MACE outcome, while statin intensity was not. This finding implies that despite recent guidelines, statin therapy should continue to be aimed at achieving specific LDL targets rather than arbitrarily selecting statins based on intensity alone.
Author Disclosures: E. Gyang: None. N. Shah: None. N. Leeper: None.
- © 2015 by American Heart Association, Inc.