In 2013, the American College of Cardiology and the American Heart Association released guidelines recommending high-intensity statin therapy for most individuals after they had undergone percutaneous coronary intervention (PCI). The most common PCI is typically placement of a stent for a blocked artery, and the use of statins lowers a person’s cholesterol levels and their risk of new arterial blockages. Third-year cardiology fellow Dr. Aref Bin Abdulhak wanted to see just how well those guidelines were followed. The results of the study were published this month in the Journal of the American Heart Association (JAHA).
Using data from the Veterans Health Administrative system, Dr. Bin Abdulhak and his co-authors examined more than 48,000 patient records from October 2010 to September 2016. This range ensured three years’ worth of data both before and after the release of the guidelines. This retrospective cohort study found that high-intensity statin use at 90 days post-PCI rose from 23% in 2010 to 80% by 2016. “Not only is that an impressive reversal,” Dr. Bin Abduhlhak says of the 57-point swing, “but there are few guidelines of any kind that ever achieve these levels of adherence.”
There are a variety of reasons some post-PCI individuals many not tolerate high-intensity statin use, but those conditions are rare and should be considered exceptional. The authors of the JAHA article project that the VA’s adherence will have reduced the 10-year risk of adverse effects from arteriosclerosis by more than 1,800 events if the cohort had otherwise received a moderate-intensity statin.
Dr. Bin Abdhulhak’s co-authors include colleagues from within the Department of Internal Medicine, many of whom have significant experience navigating VA cohort analyses: Drs. Mary Vaughan-Sarrazin, Peter Kaboli, Phil Horwitz, Hilary Mosher, and Nicholas Walker. Dr. Robert Wallace and Dr. Jennifer Robinson, epidemiologists with appointments in the College of Public Health in addition to Internal Medicine, also contributed to the article. Dr. Robinson, in fact, helped write the 2013 guidelines.