Retrospective Analysis of Cardiac Events
Background: HMG- CoA reductace inhibitors have been shown to be effective in reducing the incidence of coronary events and cardiac death. We studied the outcomes and safety of long term statin therapy for the primary and secondary prevention of cardiac events.
Methods: We conducted a retrospective study using data obtained from the medical charts of 3,070 patients under the care of cardiologists in a private outpatient medical center. Of these 34% were hyperlipidemic, 17% diabetic, 58.6% hypertensive and 26.8% smokers. Thirty four percent (34%) were followed for primary prevention, 29% had angina, 15% had previous MI and 22% CABG/PTCA. Of the 3,070 patients in the study sample, 1,046 ( 34%) were on statin therapy, 558 males (53%) and 488 females (47%) with a median age of 64.8 years. Patient outcomes were reviewed for a total period of fifteen years, from 1986 through 2000.
Results: The 1,046 patients on statins were
stratified into subgroups according to the different statins prescribed; 480
were on simvastatin (Z), 230 on atorvastatin (L), 210 on lovastatin (M), 118 on
pravastatin (P).The mean follow up duration was 118.9 months for M,48.8 months
for P,51.4 months for Z and 42.4 months for L. Outcome analysis revealed no
major hepatic or muscular complications. There were three non-fatal MIís; of
these 2 (66.7%) were on M, 1 (33.3%) was on P. Fifty one patients had CABG/PTCA;
of these, 17 were on Z (34%), 20 on M (39%),and 10 on L (20%). No patients on P
(0%) had CABG/PTCA. There were 24 patients who suffered CVA/TIA; of these 12
were on Z (50%), 7 on M (29%), 1 on P (4%) and 4 on L (16%). There were 79
cardiac deaths in the population reviewed. Of these,there were 60 cardiac deaths
(76%) in the non-statin group, and 19 ( 24%) were on statins; 2 were on Z
(2.5%), 15 on M ( 19%), 1 on P (1.2%), and 1 on L (1.2%). This represents a 52%
reduction in cardiac mortality.