Falling cholesterol trend at acute coronary syndrome presentation is strongly related to statin use for secondary prevention.

Chan, Thomas; Dabin, Bilyana; Hyun, Karice; Ranasinghe, Isuru; Neubeck, Lis; Aliprandi-Costa, Bernadette; Lefkovits, Jeffrey; Devlin, Gerard; Juergens, Craig; Chew, Derek P.; Brieger, David; Freedman, S. Ben

Abstract

Background: Lifestyle changes are believed responsible for temporal trends of reduced population total cholesterol (TC), but it is uncertain whether this applies to patients with known coronary heart disease (CHD) often prescribed lipid lowering therapy (LLT). We studied temporal TC trends at presentation with acute coronary
syndrome (ACS) to determine the contribution of LLT given for secondary prevention.
Methods: TC and LLT were obtained in 5592 patients in annual surveys of ACS admissions in Australia between 1999 and 2013, and annual mean trends analysed by linear and segmented regression.
Results: TC declined from 5.13 ± 1.1 to 4.53 ± 1.2 mmol/L (p b 0.001) and LLT (96% statin) use at presentation increased from 37.4% to 47.5% (p = 0.005). TC decline was greater in those on LLT vs. those not on therapy, with LLT contributing to 57% of the TC decline. The decline in TC and increase in LLT use was non-linear and
much steeper in those with, than without CHD history, and LLT contributed substantiallymore to the TC decline (79%, p b 0.001 vs. 27%, p=0.06 respectively). The rapid decline in TC and increase in LLT, plateauing after 2005 in those with CHD history differed markedly from trends in recent population studies, while TC trend for those without CHD history was slower, linear and consistent with population trends.
Conclusions: Declining TC level at presentation for ACS was strongly associated with increasing LLT use in those with a history of CHD, indicating that increasing uptake of LLT for secondary prevention has impacted TC changes in the new millennium.

Citation

Chan, T., Dabin, B., Hyun, K., Ranasinghe, I., Neubeck, L., Aliprandi-Costa, B., Lefkovits, J., Devlin, G., Juergens, C., Chew, D. P., Brieger, D., & Freedman, S. B. (2016). Falling cholesterol trend at acute coronary syndrome presentation is strongly related to statin use for secondary prevention. International Journal of Cardiology, 212(1), 192-197. https://doi.org/10.1016/j.ijcard.2016.03.038

• Journal Article Type: Article
• Acceptance Date: Mar 13, 2016
• Online Publication Date: Mar 16, 2016
• Publication Date: Mar 16, 2016
• Deposit Date: Oct 24, 2016
• Journal: International Journal of Cardiology
• Print ISSN: 0167-5273
• Electronic ISSN: 1874-1754
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 212
• Issue: 1
• Pages: 192-197
• DOI: https://doi.org/10.1016/j.ijcard.2016.03.038
• Keywords: Cholesterol, statin therapy, acute coronary syndrome, temporal trend,
• Public URL: http://researchrepository.napier.ac.uk/Output/407477