Abstract Body (Do not enter title and authors here): Background: Lipid-lowering therapy plays a crucial role in the secondary prevention of coronary artery disease (CAD), particularly following acute myocardial infarction (AMI). While International Guidelines recommend the early initiation of high-intensity statins post-AMI, there remains limited insight into the patterns of lipid-lowering drug utilization across healthcare systems.
Purpose: This study aims to analyze the temporal trends and influencing factors associated with the utilization of lipid-lowering therapy, with a focus on high-intensity statins, among patients hospitalized with AMI.
Methods: Using data spanning 2012 to 2020 from the Japanese Registry of All Cardiac and Vascular Diseases (JROAD-DPC), including all procedures and prescriptions during hospitalization, we examined 381,046 AMI cases discharged alive from 1,091 hospitals. We defined lipid-lowering therapies as the use of statins, ezetimibe, or PCSK9 inhibitors, and high-intensity statin use based on the following dosages due to insurance limits in Japan: Atorvastatin 20 mg, Rosuvastatin 10 mg, or Pitavastatin 4 mg per day. We investigated trends in lipid-lowering drug and high-intensity statin use and examined associated factors through subcategory analysis, developing a multivariate mixed logistic regression model with each institute considered a random intercept.
Results: Within the cohort (with an average age of 69.2 years and comprising 26.5% females), the proportion of patients receiving any form of lipid-lowering therapies increased from 78.0% to 88.2% between 2012 and 2020. Among these individuals, the percentage of those prescribed any statins rose from 77.8% to 85.8% over the same period. However, the utilization of high-intensity statins remained relatively low, accounting for only 31.3% of cases in 2020 (Figure). In subgroup analyses, the usage of high-intensity statins was notably lower among females (26.8%) compared to males (32.9%) in 2020 (p<0.001). Upon adjusting for multivariate factors, including comorbidities and AMI severity, females exhibited a significantly lower likelihood of receiving high-intensity statin therapy, with an odds ratio of 0.92 (95% CI [0.89, 0.94], p<0.001).
Conclusion: The early initiation of high-intensity statins post-AMI remains suboptimal. Disparities in utilization exist for females compared to males. Efforts to promote early adoptation of high-intensity statins are warranted to optimize secondary prevention strategies for AMI patients.