Statin prescribing pattern and the outcomes for acute coronary syndrome as primary and secondary prevention: a comprehensive review
Abstract
Cardiovascular disease is the highest rate of total burden non-communicable disease worldwide in these 5 recent years. Reducing the LDL-c level is closely related to reducing the risk of cardiovascular events recurrences among Acute Coronary Syndrome (ACS) patients. This review aimed to explore the statin prescribing pattern among the ACS population and population at risk of ACS and to sum up the reported clinical outcomes, cost-effectiveness, or quality of life-related to statin utilization. The literature searching was conducted by using PubMed and Scopus databases from January 2020 to December 2021. Ten eligible studies were included, examining outcomes such as Major Adverse Cardiovascular Events (MACE), quality of life, and cost-effectiveness. Atorvastatin emerged as the most frequently prescribed statin for both primary and secondary prevention. In high-risk ACS populations, the delayed or underutilization of high-intensity statins led to suboptimal cardiovascular outcomes. Conversely, early administration, particularly within 48 hours post-event or post-PCI, significantly reduced MACE. Importantly, low to moderate intensity statin regimens showed cost-effectiveness primarily among low-risk ACS groups only when treatment was fully subsidized. In settings without government coverage, statin inaccessibility may affect the increased of recurrent events and elevated healthcare costs. The strategic use of statins—especially timely initiation and risk-based intensity selection—offers measurable benefits in reducing cardiovascular events. However, the lack of universal healthcare coverage for statin therapy in low- to middle-income settings presents a substantial barrier to cost-effective care, particularly for high-risk individuals. These findings underscore the need for policy interventions and expanded access to guideline-directed statin therapy.
References
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[33] M. Valentino, J. Al Danaf, A. Panakos, L. Ragupathi, D. Duffy, and D. Whellan, “Impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on the prescription of high-intensity statins in patients hospitalized for acute coronary syndrome or stroke,” Am Heart J, vol. 181, pp. 130–136, Nov. 2016, doi: 10.1016/j.ahj.2016.07.024.
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[35] P. S. Chan, B. K. Nallamothu, H. S. Gurm, R. A. Hayward, and S. Vijan, “Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients With Coronary Artery Disease,” Circulation, vol. 115, no. 18, pp. 2398–2409, May 2007, doi: 10.1161/CIRCULATIONAHA.106.667683.
[2] F. Mach et al., “2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk,” Eur Heart J, vol. 41, no. 1, pp. 111–188, Jan. 2020, doi: 10.1093/eurheartj/ehz455.
[3] M. Ruscica, C. Macchi, C. Pavanello, A. Corsini, A. Sahebkar, and C. R. Sirtori, “Appropriateness of statin prescription in the elderly,” Eur J Intern Med, vol. 50, pp. 33–40, Apr. 2018, doi: 10.1016/j.ejim.2017.12.011.
[4] E. Rossini et al., “Statins in High Cardiovascular Risk Patients: Do Comorbidities and Characteristics Matter?,” Int J Mol Sci, vol. 23, no. 16, p. 9326, Aug. 2022, doi: 10.3390/ijms23169326.
[5] I. Lin et al., “Patterns of Statin Use in a Real-World Population of Patients at High Cardiovascular Risk,” J Manag Care Spec Pharm, vol. 22, no. 6, pp. 685–698, Jun. 2016, doi: 10.18553/jmcp.2016.22.6.685.
[6] D. E. McNavish, C. A. German, and M. D. Shapiro, “Should a Statin be Given to All Hypertensive Patients?,” Curr Hypertens Rep, vol. 24, no. 1, pp. 21–27, Jan. 2022, doi: 10.1007/s11906-022-01167-8.
[7] D. M. Diamond, B. T. Bikman, and P. Mason, “Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet,” Curr Opin Endocrinol Diabetes Obes, vol. 29, no. 5, pp. 497–511, Oct. 2022, doi: 10.1097/MED.0000000000000764.
[8] P. Njoku, I. Meka, and N. Mbadiwe, “Pre-operative lipid profile of cardiac surgery patients: Implications of incidental findings,” International Journal of Medicine and Health Development, vol. 27, no. 2, p. 131, 2022, doi: 10.4103/ijmh.IJMH_43_21.
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[10] X. Ye, C. R. Gross, J. Schommer, R. Cline, J. Xua, and W. L. St. Peter, “Initiation of Statins After Hospitalization for Coronary Heart Disease,” Journal of Managed Care Pharmacy, vol. 13, no. 5, pp. 385–396, Jun. 2007, doi: 10.18553/jmcp.2007.13.5.385.
[11] M. Kim et al., “Current Statin Usage for Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Multicenter Survey in Korea,” Clin Cardiol, vol. 35, no. 11, pp. 700–706, Nov. 2012, doi: 10.1002/clc.22038.
[12] M. Mahadevappa, C. Meher, N. Pushpa, P. Kulkarni, K. Poornima, and N. Desai, “Study of pattern & distribution of adverse drug reactions in acute coronary syndrome patients in a tertiary care hospital,” Indian Journal of Medical Research, vol. 156, no. 1, p. 111, 2022, doi: 10.4103/ijmr.IJMR_1275_20.
[13] S. K. Lakshmi, H. N. Gowda, and K. S. Sadananda, “A study of drug utilization trends in acute coronary syndrome in intensive cardiac care unit at a tertiary care hospital, Mysore,” Int J Basic Clin Pharmacol, vol. 6, no. 2, p. 344, Jan. 2017, doi: 10.18203/2319-2003.ijbcp20170327.
[14]. MR Sravani and J Naresh Venkat. Avula Naveen, “Drug utilization patterns in acute coronary syndrome at a tertiary care teaching hospital: A retrospective, non interventional and observational study’, ,” The Pharma Journa, vol. 6, pp. 538–544, 2017.
[15] S. H. Boklage, E. Malangone-Monaco, L. Lopez-Gonzalez, Y. Ding, C. Henriques, and J. Elassal, “Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions,” Cardiovasc Drugs Ther, vol. 32, no. 3, pp. 273–280, Jun. 2018, doi: 10.1007/s10557-018-6800-3.
[16] M. B. Mortensen, I. Kulenovic, and E. Falk, “Statin use and cardiovascular risk factors in diabetic patients developing a first myocardial infarction,” Cardiovasc Diabetol, vol. 15, no. 1, p. 81, Dec. 2016, doi: 10.1186/s12933-016-0400-y.
[17] Y. Sun et al., “Prescription of statins at discharge and 1‐year risk of major clinical outcomes among acute coronary syndromes patients with extremely low LDL‐cholesterol in clinical pathways for acute coronary syndromes studies,” Clin Cardiol, vol. 41, no. 9, pp. 1192–1200, Sep. 2018, doi: 10.1002/clc.23040.
[18] G. G. Schwartz, R. Fayyad, M. Szarek, D. DeMicco, and A. G. Olsson, “Early, intensive statin treatment reduces ‘hard’ cardiovascular outcomes after acute coronary syndrome,” Eur J Prev Cardiol, vol. 24, no. 12, pp. 1294–1296, Aug. 2017, doi: 10.1177/2047487317708677.
[19] L. D. Lazar, M. J. Pletcher, P. G. Coxson, K. Bibbins-Domingo, and L. Goldman, “Cost-Effectiveness of Statin Therapy for Primary Prevention in a Low-Cost Statin Era,” Circulation, vol. 124, no. 2, pp. 146–153, Jul. 2011, doi: 10.1161/CIRCULATIONAHA.110.986349.
[20] Z. Ademi et al., “Cost-Effectiveness of Optimizing Use of Statins in Australia: Using Outpatient Data From the REACH Registry,” Clin Ther, vol. 33, no. 10, pp. 1456–1465, Oct. 2011, doi: 10.1016/j.clinthera.2011.08.004.
[21] S. Nakao, H. Kawabe, H. Takuma, and M. Shiragami, “Acceptable Incremental Cost Effectiveness Ratio for Use of New Drugs, Cases in Statin Therapies,” YAKUGAKU ZASSHI, vol. 130, no. 10, pp. 1347–1352, Oct. 2010, doi: 10.1248/yakushi.130.1347.
[22] S. Ward et al., “A systematic review and economic evaluation of statins for the prevention of coronary events,” Health Technol Assess (Rockv), vol. 11, no. 14, Apr. 2007, doi: 10.3310/hta11140.
[23] I. Uchmanowicz, M. Lisiak, M. Wleklik, P. Gurowiec, and M. Kałużna–Oleksy, “The relationship between frailty syndrome and quality of life in older patients following acute coronary syndrome,” Clin Interv Aging, vol. Volume 14, pp. 805–816, May 2019, doi: 10.2147/CIA.S204121.
[24] H. S. Kim, H. K. Kim, K. O. Kang, and Y. S. Kim, “Determinants of health‐related quality of life among outpatients with acute coronary artery disease after percutaneous coronary intervention,” Japan Journal of Nursing Science, vol. 16, no. 1, pp. 3–16, Jan. 2019, doi: 10.1111/jjns.12209.
[25] T. Horikoshi et al., “Stratification Analysis of Statin Effect on Major Adverse Cardiac Events After Percutaneous Coronary Intervention in Patients on Hemodialysis,” J Cardiovasc Pharmacol, vol. 79, no. 2, pp. 168–176, Feb. 2022, doi: 10.1097/FJC.0000000000001152.
[26] J. A. Borovac et al., “Efficacy of high-dose atorvastatin or rosuvastatin loading in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials with GRADE qualification of available evidence,” Eur J Clin Pharmacol, vol. 78, no. 1, pp. 111–126, Jan. 2022, doi: 10.1007/s00228-021-03196-9.
[27] P. E. N. Dewi and M. Thavorncharoensap, “Statin Utilization among Patients with Acute Coronary Syndrome: Systematic Review,” Open Access Maced J Med Sci, vol. 9, no. T4, pp. 267–278, May 2021, doi: 10.3889/oamjms.2021.5807.
[28] N. P. E. Kadoglou and M. Stasinopoulou, “How to Use Statins in Secondary Prevention of Atherosclerotic Diseases: from the Beneficial Early Initiation to the Potentially Unfavorable Discontinuation,” Cardiovasc Drugs Ther, vol. 37, no. 2, pp. 353–362, Apr. 2023, doi: 10.1007/s10557-021-07233-8.
[29] M. Leoncini, A. Toso, M. Maioli, F. Tropeano, S. Villani, and F. Bellandi, “Early High-Dose Rosuvastatin for Contrast-Induced Nephropathy Prevention in Acute Coronary Syndrome,” J Am Coll Cardiol, vol. 63, no. 1, pp. 71–79, Jan. 2014, doi: 10.1016/j.jacc.2013.04.105.
[30] A. Toso, M. Leoncini, M. Maioli, F. Tropeano, S. Villani, and F. Bellandi, “A Prospective, Randomized, Open-
Label Trial of Atorvastatin versus Rosuvastatin in the Prevention of Contrast-Induced Acute Kidney Injury, Worsened Renal Function at 30 Days, and Clinical Events After Acute Coronary Angiography: the PRATO-ACS-2 Study,” Cardiorenal Med, vol. 10, no. 5, pp. 288–301, 2020, doi: 10.1159/000506857.
[31] F. Angeli, G. Reboldi, M. Garofoli, E. Ramundo, and P. Verdecchia, “Very early initiation of statin therapy and mortality in patients with acute coronary syndrome,” Acute Cardiac Care, vol. 14, no. 1, pp. 34–39, Mar. 2012, doi: 10.3109/17482941.2012.655297.
[32] S. Yu, J. Jin, Z. Chen, and X. Luo, “High-intensity statin therapy yields better outcomes in acute coronary syndrome patients: a meta-analysis involving 26,497 patients,” Lipids Health Dis, vol. 19, no. 1, p. 194, Dec. 2020, doi: 10.1186/s12944-020-01369-6.
[33] M. Valentino, J. Al Danaf, A. Panakos, L. Ragupathi, D. Duffy, and D. Whellan, “Impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on the prescription of high-intensity statins in patients hospitalized for acute coronary syndrome or stroke,” Am Heart J, vol. 181, pp. 130–136, Nov. 2016, doi: 10.1016/j.ahj.2016.07.024.
[34] D. K. Arnett et al., “2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” Circulation, vol. 140, no. 11, Sep. 2019, doi: 10.1161/CIR.0000000000000678.
[35] P. S. Chan, B. K. Nallamothu, H. S. Gurm, R. A. Hayward, and S. Vijan, “Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients With Coronary Artery Disease,” Circulation, vol. 115, no. 18, pp. 2398–2409, May 2007, doi: 10.1161/CIRCULATIONAHA.106.667683.
Published
2025-04-30
How to Cite
DEWI, Pramitha Esha Nirmala; CHAIRANI, Farahdina; HIMAWAN, Wahyu.
Statin prescribing pattern and the outcomes for acute coronary syndrome as primary and secondary prevention: a comprehensive review.
JURNAL ILMU KEFARMASIAN INDONESIA, [S.l.], v. 23, n. 1, p. 8-17, apr. 2025.
ISSN 2614-6495.
Available at: <http://jifi.farmasi.univpancasila.ac.id/index.php/jifi/article/view/1604>. Date accessed: 04 may 2025.
doi: https://doi.org/10.35814/jifi.v23i1.1604.
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