Temporal patterns of lipid testing and statin therapy in acute coronary syndrome patients (from the canadian grace experience)

The American Journal of Cardiology, 05/07/2012

There has been a significant temporal increase in the use of in–hospital statin therapy but only a minor increase in lipid testing. Lipid testing was strongly associated with in–hospital statin use. A substantial proportion of patients with acute coronary syndrome (ACS), especially those at higher risk, still do not receive these guideline–recommended interventions in contemporary practice.

Methods

  • Current guidelines recommend the measurement of fasting lipid profile and use of statins in all patients with acute coronary syndrome (ACS).
  • However, the temporal trends of lipid testing and statin therapy in “real–world” patients with ACS are unclear.
  • From January 1999 through December 2008, the prospective, multicenter, Global Registry of Acute Coronary Events (GRACE/GRACE2/CANRACE) enrolled 13,947 patients with ACS in Canada.
  • Authors stratified the study population based on year of presentation into 3 groups (1999 to 2004, 2005 to 2006, and 2007 to 2008) and compared the use of lipid testing and use of statin therapy in hospital.
  • Overall, 70.8% of patients underwent lipid testing and 79.4% received in–hospital statin therapy; these patients were younger and had lower GRACE risk scores (p <0.001 for the 2 comparisons) compared to those who did not.

Results

  • Over time there was a significant increase in rates of in–hospital statin therapy (70% in 1999 to 2004 to 84.5% in 2007 to 2008, p for trend < 0.001) but only a minor increase in rates of lipid testing (69.4% in 1999 to 2004 to 72.4% in 2007 to 2008, p for trend = 0.003).
  • After adjusting for confounders, this increasing temporal trend remained statistically significant for statin therapy (p <0.001) but not for lipid testing.
  • Lipid testing was independently associated with in–hospital statin use (adjusted odds ratio 1.62, 95% confidence interval 1.27 to 2.08, p <0.001).
  • In patients who did have lipid testing, those with low–density lipoprotein cholesterol level >130 mg/dl (3.4 mmol/L) were more likely to be treated with in–hospital statins.

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