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Clinical Outcomes of High-Intensity Doses of Atorvastatin in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study Using Real-World Data
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  • Alaa Rahhal,
  • Fadi Khir,
  • Amer Aljundi,
  • Yaser AlAhmad,
  • Hakam Alzaeem,
  • Masa Habra,
  • Israa Alshekh,
  • Ahmed Mahfouz,
  • Ahmed Awaisu,
  • Sumaya Al-Yafei ,
  • Abdul Rahman Arabi
Alaa Rahhal
Heart Hospital, Hamad Medical Corporation
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Fadi Khir
Hamad General Hospital, Hamad Medical Corporation
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Amer Aljundi
Heart Hospital, Hamad Medical Corporation
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Yaser AlAhmad
Heart Hospital, Hamad Medical Corporation
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Hakam Alzaeem
Heart Hospital, Hamad Medical Corporation
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Masa Habra
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Israa Alshekh
Hamad General Hospital, Hamad Medical Corporation
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Ahmed Mahfouz
Heart Hospital, Hamad Medical Corporat
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Ahmed Awaisu
Qatar University
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Sumaya Al-Yafei
Heart Hospital, Hamad Medical Corporation
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Abdul Rahman Arabi
Heart Hospital, Hamad Medical Corporation
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Abstract

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.

Peer review status:IN REVISION

11 Jul 2020Submitted to British Journal of Clinical Pharmacology
13 Jul 2020Submission Checks Completed
13 Jul 2020Assigned to Editor
14 Jul 2020Reviewer(s) Assigned
29 Aug 2020Review(s) Completed, Editorial Evaluation Pending
02 Sep 2020Editorial Decision: Revise Major
19 Sep 20201st Revision Received
21 Sep 2020Submission Checks Completed
21 Sep 2020Assigned to Editor
21 Sep 2020Review(s) Completed, Editorial Evaluation Pending
26 Sep 2020Editorial Decision: Revise Minor
27 Sep 20202nd Revision Received