This retrospective study evaluated statin therapy intensity, LDL-C levels, and recurrent ASCVD events in adults with prior coronary revascularization within a large health system. Patients were categorized as guideline-directed statin intensity (GDSI), <GDSI, or no statin therapy and followed for a median of about six years.
Recurrent outcomes included myocardial infarction, ischemic stroke/TIA, myocardial infarction with revascularization, and all-cause mortality. Overall, 65% were on GDSI, 25% on <GDSI, and 10% not on statins.
Event rates differed markedly by statin intensity: MI rates were 21.6% with GDSI versus 34.8% (<GDSI) and 65.3% (no statin); combined MI/revascularization rates were 38.7% with GDSI vs 57.5% (<GDSI) and 93.9% (no statin); and ischemic stroke/TIA rates were 10.7% with GDSI vs 17.7% (<GDSI) and 24.6% (no statin). LDL-C levels at or below 70 mg/dL were associated with fewer adverse events.
Multivariable analysis indicated that GDSI reduction in recurrent ASCVD events and mortality was significant. The study’s conclusions indicate that higher statin intensity correlates with fewer recurrent events and deaths; uncertainty remains regarding causation due to the observational design.