High-potency statin use in patients who had heart attacks may lower mortality risk compared with simvastatin monotherapy, according to a study published online Feb. 19 in Heart.
Maheshwar Pauriah, MBBS, MRCP, of the University of Dundee in Scotland, and colleagues sought to compare the risk of mortality from any cause in patients who experienced an incident acute MI (AMI) and were treated with simvastatin (Zocor, Merck) monotherapy with AMI patients treated with high-potency statins and a combination of simvastatin and ezetimibe (Zetia, Merck).
They evaluated data from the United Kingdom General Practice Research Database on 9,597 patients who survived 30 days after an incident AMI, were previously naïve to statins or ezetimibe and started on statin therapy within 30 days of their AMI. They identified three groups of patients based on their therapy regimen—simvastatin monotherapy; high-potency statin, which included patients started on simvastatin but switched to atorvastatin (Lipitor, Pfizer) or rosuvastatin (Crestor, AstraZeneca); and ezetimibe/statin combination.
Of the 9,597 patients, 72.8 percent were in the simvastatin only group, 19.6 percent were in the high-potency statin group and 7.5 percent were in the combination group. Twelve percent of patients died after an average follow-up of 3.2 years.
Patients who switched to a high-potency statin had a lower risk of death than patients in the simvastatin alone group (hazard ratio [HR] 0.72), and adding ezetimibe was not beneficial (HR 0.96). Results were similar after adjusting for other variables that could have affected prognosis. They noted, however, that the combination group was small in comparison to the other two groups.
The authors explained that their study supports using high-potency statins in this population of patients and questions the addition of ezetimibe. But they added that a study is currently under way that is evaluating the effect of combination therapy with simvastatin and ezetimibe compared with simvastatin monotherapy on the risk of cardiovascular events.
“[F]or the moment, the data support the use of high-potency statins, one of which, atorvastatin, is now off patent and is cheap and effective,” said co-author Chim Lang of the University of Dundee Medical School, in a press release.