Three-year mortality of patients with cardiovascular risk receiving lipid-lowering therapy using statins in clinical practice in Thailand

Abstract

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 personyears after starting statin treatment. Patients with a high and very high risk for CHD need more aggressive lipid-lowering management than usual.