Statin Use and Severity of First Manifestation of Coronary Heart Disease Across Age and Sex

Introduction: We investigate whether treatment recommendations for statins in primary prevention of cardiovascular disease (CVD) based on sex, age and risk factors translate to better CV outcomes in current routine clinical care. Methods: We studied a propensity match-weighted cohort of 14,542 Caucasian patients presenting with a first manifestation of CVD from the International Survey of Acute Coronary Syndromes (ISACS) Archives databank (NCT04008173) . Main outcome measures were the incidence of ST segment elevation myocardial infarction (STEMI) and acute heart failure (HF) on hospital admission. Results: Prior statin use was associated with a significantly decreased rate of STEMI (absolute difference 10.2%; RR ratio, 0.64; 95%CI 0.58 to 0.71) and acute HF (absolute difference 4.3%; RR ratio 0.72, 95% CI 0.62 to 0.83). Benefits were not attenuated when controlling for age 75 years and older (RR ratios 0.59, 95% CI 0.46 to 0.75 for STEMI and 0.66, 95% CI 0.50 to 0.87 for HF). Statin therapy had no effect in patients with 10-year ASCVD risk threshold less than 10% (RR ratios:0.85,95%CI:0.66- 1.08 for STEMI and 0.85,95%CI:0.60-1.20 for HF). Reductions in major CV events with statins diminished with female sex (interaction p=0.0200 for STEMI, and 0.2180 for HF). Moreover, statin use determined a lower risk of 30-day mortality in patients presenting with HF on admission (5.2 % absolute risk reduction and a 29% relative risk reduction). Conclusions: Prevention statin therapy reduces the risk of STEMI and acute HF with benefit in mortality from HF. The most gain is attained in male sex and in subjects with 10-year ASCVD risk ≥10%