Statin Use and Recurrent Atherosclerotic Cardiovascular Disease Events in Patients With Coronary Artery Intervention: A Retrospective Analysis From a Large Health Care Network

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) poses a significant health challenge worldwide. While statins effectively reduce low-density lipoprotein (LDL) cholesterol and lower cardiovascular risk, patients with coronary artery disease who undergo revascularization remain vulnerable to recurrent ASCVD events. This study examined the link between statin intensity, LDL cholesterol levels, and recurrent ASCVD events in patients undergoing coronary interventions within a large health care system. METHODS: We conducted a retrospective analysis using the University of Pittsburgh Medical Center database, including patients aged ≥18 with coronary artery disease confirmed by revascularization (coronary artery bypass graft or percutaneous coronary intervention) since January 2010. Patients were categorized by statin intensity: guideline-directed statin intensity (GDSI), less than GDSI (<GDSI), or no statin therapy. Outcomes included recurrent myocardial infarction, ischemic stroke, and all-cause mortality over a median 6-year follow-up. RESULTS: Of 45 949 patients (69% men), 65% were on GDSI, 25% on <GDSI, and 10% were not on statins. GDSI patients compared with those on <GDSI or no statins had lower rates of myocardial infarction (21.6 versus 34.8 versus 65.3), myocardial infarction/revascularization (38.7 versus 57.5 versus 93.9), and ischemic stroke/transient ischemic attack (10.7 versus 17.7 versus 24.6) (P<0.001 for all). LDL cholesterol levels ≤70 mg/dL correlated with fewer adverse events, multivariable analysis indicated that GDSI significantly lowered recurrent ASCVD events and mortality. CONCLUSIONS: GDSI reduces recurrent ASCVD events and mortality more effectively than less intensive regimens or no statins. Optimizing statin use and LDL cholesterol monitoring could improve ASCVD management and outcomes.