Author + information
- Pierre-Vladimir Ennezat, MD∗ ( and )
- Raphaëlle-Ashley Guerbaai, MSc, BN
- ↵∗Centre Hospitalier Universitaire de Grenoble, Service de Cardiologie, BP 217, 38043 Grenoble Cedex 09, France
We have read with great interest the paper by Serban et al. (1) on the prognostic value of discontinuing or reducing statin therapy or switching to ezetimibe in patients with coronary artery disease after being hospitalized for myocardial infarction (MI).
It is interesting to note that an increase in reoccurrence of MIs and coronary events is not linked with an increase in mortality. Moreover, it seems important to adjust for other variables such as antiplatelet treatment compliance or smoking because these are some of the major cardiovascular risk factors. Smoking cessation is indeed responsible for a reduction in mortality of about one-third (2). Conversely, data from the Organization to Assess Strategies in Acute Ischemic Syndromes trial (3) showed that persistent smokers who also did not modify diet or exercise had the highest risk of a repeat cardiovascular event (odds ratio: 3.77; 95% confidence interval: 2.40 to 5.91). Interruption of antiplatelet therapy is practically always unavoidably responsible for a rapid increase of coronary thrombotic events in patients with previous coronary revascularization. Similarly, a Danish study showed that early statin discontinuation resulted in both a 26% increase in risk for MI and an 18% increase for cardiovascular mortality versus individuals with continued use; unfortunately, the impact on total mortality was not disclosed, and adjustment on tobacco use and antiplatelet treatment compliance was not performed (4). Finally, it is worth questioning why Amgen support was required to analyze retrospective Medicare data, and what the sponsor’s role was in the analysis, selection of variables, and final study report.
Please note: Dr. Ennezat has reported that he has received honoraria from Philips, AstraZeneca, and Daiichi-Sankyo for echocardiography lectures. R.-A. Guerbaai has reported that she has no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
- Serban M.C.,
- Colantonio L.D.,
- Manthripragada A.D.,
- et al.
- Chow C.K.,
- Jolly S.,
- Rao-Melacini P.,
- Fox K.A.,
- Anand S.S.,
- Yusuf S.
- Nielsen S.F.,
- Nordestgaard B.G.