High-dose Statins as a Secondary Prevention

A new study suggests high-dose statins benefit patients for a secondary prevention. The records of more than 500,000 VA patients presenting with atherosclerotic cardiovascular disease (ASCVD) were reviewed to compare all-cause mortality with statin dosing. The study spanned nearly 500 days of follow-up and included about 20% women. Just over 29.6% of all patients received high-intensity statin therapy, 45.6% were on moderate-intensity therapy, 6.7% were on low-dose therapy, and 18% were on no statin. High-dose therapy was defined as atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day. The mortality rate was the lowest in the high-dose group (4.0%), followed by the moderate-intensity group (4.8%), then low intensity (5.7%). The highest mortality was in the group on no statin (6.6%; P < 0.001). Patients 76-84 years of age benefitted similarly to younger patients. The authors concluded that there was a graded association between intensity of statin therapy and mortality in patients suffering from ASCVD. High-intensity statins were associated with a small but significant survival advantage compared with moderate-intensity statins, even among older adults. Maximal doses of high-intensity statins were associated with a further survival benefit. (JAMA Cardiol. Published online Nov. 9, 2016. doi:10.1001/jamacardio.2016.4052)