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.

Conclusion: This study confirms a significant reduction in non-fatal MIís and cardiac deaths in patients while on statin therapy. There were differences in outcomes among the statins regardless of their efficacy in lowering Total and LDL cholesterol levels.