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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2015 October;174(10):441-7
Three-year mortality of patients with cardiovascular risk receiving lipid-lowering therapy using statins in clinical practice in Thailand
Sriratanasathavorn C. 1, Silaruks S. 2, Rawdaree P. 3, Kunjara-Na-Ayudhaya R. 4, Thinkhamrop B. 5, Sritara P. 6
1 Her Majesty Cardiac Center, Siriraj Hospital, Mahidol University, Siriraj, Tailandia;
2 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Tailandia;
3 Endocrinology Unit, BMA Medical College and Vajira Hospital, Bangkok, Tailandia;
4 Vichaiyut Hospital, Bangkok, Tailandia;
5 Department of Biostatistics and Demography Faculty of Public Health, Khon Kaen, Tailandia;
6 Cardiology Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Tailandia
AIM: We assessed overall mortality among dyslipidemia patients in clinical practice in Thailand: all participants were receiving lipid-lowering statins.
METHODS: A total of 1240 patients were selected consecutively from 50 hospitals across Thailand. Patients were enrolled if treated with statins for at least 3 months. Mortality was determined over 3 years. Patients were classified as: (1) very high risk – post myocardial infarction with diabetes mellitus (DM), or post-stroke with DM, or peripheral artery disease with DM; (b) high risk – coronary artery disease, or cardiovascular disease, or post-stroke, or DM; or, (c) moderate risk – 2 or more risks plus either hypertension or dyslipidemia. Mortality was estimated using the exact Poisson distribution and compared between groups using a multivariable Cox proportional hazards regression model.
RESULTS: Overall, two-thirds of the patients were female, mean age was 61.7±9.5 and 73.7% were at high-risk. One-half (51.1%) achieved the LDL-C guideline goals. Over the 3-year follow-up, the mortality rate was 10.1% (95%CI: 8.5% to 11.9%). Overall mortality since beginning statin treatment was 1.7 per 100 person-years (95%CI: 1.4 to 2.0). Heart failure was the most common cause of death (17.6%): 18.6% in the very high risk group (p-value = 0.005). The respective risk of death in the high and very high risk group was double and quadruple of that in the moderate risk group (HR 2.0; 95%CI: 1.2 to 3.3, p-value = 0.012 vs. HR 3.9; 95%CI: 1.7 to 9.1; p-value = 0.002).
CONCLUSION: Among patients with a cardiovascular risk—half of whom achieved the prescribed LDL-C goals—10% died within 3 years of enrolment, i.e. 1.7 per 100 person-years after starting statin treatment. Patients with a high and very high risk for CHD need more aggressive lipid-lowering management than usual.