Clinical Outcomes of High-Intensity Doses of Atorvastatin in Patients
with Acute Coronary Syndrome: A Retrospective Cohort Study Using
Abstract Aim: To compare the effectiveness and safety of two
high-intensity atorvastatin doses (40mg vs. 80mg) among acute coronary
syndrome (ACS) patients. Methods: This retrospective observational
cohort study using real-world data included patients admitted with ACS
to the Heart Hospital in Qatar between January 1, 2017 and December 31,
2018. The primary endpoint was a composite of cardiovascular disease
(CVD)-associated death, non-fatal ACS, and non-fatal stroke. Cox
proportional hazard regression analysis was used to determine the
association between the two high-intensity atorvastatin dosing regimens
and the primary outcome at 1 month and 12 months post-discharge.
Results: Of the 626 patients included in the analyses, 475 (75.9%)
received atorvastatin 40mg, while 151 (24.1%) received atorvastatin
80mg following ACS. Most of the patients were Asian (73%), male (97%)
with a mean age of 50 years, and presented with ST-elevation myocardial
infarction (60%). The incidence of the primary effectiveness outcome
did not differ between the atorvastatin 40mg and 80mg groups at 1 month
(0.8% vs. 1.3%; aHR= 0.59, 95% CI 0.04-8.13, p= 0.690) and at 12
months (3.2% vs. 4%; aHR= 0.57, 95% CI 0.18-1.80, p= 0.340).
Similarly, the use of the two doses of atorvastatin resulted in
comparable safety outcomes, including liver toxicity, myopathy, and
rhabdomyolysis with an event rate of < 1% in both groups.
Conclusion: The use of atorvastatin 40mg in comparison to atorvastatin
80mg in patients with ACS resulted in similar cardiovascular
effectiveness and safety outcomes.