Insufficient use of statins in the primary and secondary prevention of myocardial infarction: an urgent problem in modern cardiology

Relevance. Myocardial infarction (MI) remains one of the leading causes of death and disability worldwide. The high prevalence of this atherosclerosis-associated disease is undoubtedly associated with insufficient prevention of cardiovascular diseases, including due to insufficient use of statins. This article highlights the problem of evaluating the use of statins as a means of primary and secondary cardiovascular prevention using the example of myocardial infarction from a sample of patients in the Siberian region.

Objective. To evaluate the frequency of statin use in patients before the onset of primary and recurrent type 1 myocardial infarction.

Materials and methods. The open continuous cross-sectional study included 294 patients selected from the local registry of acute coronary syndrome, treated at the 1st cardiology department of the Novosibirsk State Clinical Hospital No. 1 in 2021–2023. A multifactorial logistic regression model was used to assess the effect of various factors on the use of statins at the prehospital stage.

Results. It was found that in the subgroup of primary MI, the frequency of statin use was 21.8 %, and in the subgroup of repeated MI, the frequency was 38.6 %. An analysis of the factors associated with statin use revealed a statistically significant association with repeated myocardial infarction, OR 2.26 (1.29–3.99), and with dyslipidemia, OR 1.81 (1.02–3.25). Other factors: hypertension, diabetes mellitus type 2, obesity, atrial fibrillation, left ventricular ejection fraction, creatinine levels, age and gender. They have not reached the level of significance. The doses of the drugs corresponded to clinical recommendations; in 70 % of cases, atorvastatin was used, and in 30 %, rosuvastatin was used. Among the patients taking statins, many (more than 2/3 of the patients) did not reach the target values of LDL cholesterol.

Conclusions. The present study demonstrates insufficient frequency, intensity and duration of statin therapy among patients hospitalized with primary and recurrent type 1 myocardial infarction, and this indicates a poor state of primary and secondary prevention of this preventable cardiovascular event.

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