STATINS AND SEVERITY OF CLINICAL MANIFESTATIONS AMONG WOMEN AND MEN WITH INCIDENT CORONARY HEART DISEASE

Background: Controversies persist about the role of statins in primary prevention of atherosclerotic cardiovascular disease (ASCVD). We sought to determine whether initiation of statin therapy for primary prevention of cardiovascular disease may lead to a reduction in cardiovascular outcomes across age, sex, and risk factors. Methods: We investigated 14,542 patients aged ≥40 years presenting to hospitals with ACS as first manifestation of cardiovascular disease from 2010 to 2019 in the ISACS Archives network of registries (NCT04008173). Individual risk of STEMI, acute heart failure (HF) on hospital admission and all-cause 30-day mortality were assessed using inverse probability of treatment weighting models matching for concomitant medications. Acute HF was defined as Killip class≥ 2. Estimates were compared by test of interaction on the log scale. Results: Among the study population 12.5% of patients were on statin therapy. Mean (SD) estimated 10-year risk for ASCVD was 25.8 (17.9) in statin users vs 22.5 (17.1) in non-users. The risk of STEMI was much lower in the statin-users than in the non-users (relative risk [RR] ratio 0.64; 95%CI 0.58-0.71). This effect persisted in both sexes, but was substantially stronger in men (absolute reduction: 11.5%; RR ratio: 0.61, 95%CI: 0.54-0.69) than in women (absolute reduction: 6.3%; RR ratio: 0.76, 95% CI: 0.64-0.90, p interaction=0.02). These benefits translated into reductions in acute HF on hospital admission with statin therapy for both women (RR ratio 0.66, 95%CI: 0.53-0.83) and men (RR ratio 0.74, 95%CI 0.62-0.89; p interaction=0.22). No effect on the rates of STEMI or acute HF was noted in patients with 10-year ASCVD risk lower than 10% for either sex. Acute HF was predictive of mortality at 30 days both in women and in men. Conclusion: Preventive statin therapy reduces the risk of STEMI as initial manifestation of cardiovascular disease and acute HF with potential benefits in mortality. The most gain is attained in male subjects with 10-year CV risk equal or more than 10%.