Low statin use in adults hospitalized with acute coronary syndrome

- Adults were stratified using recommended risk calculators for primary prevention.
- Only one-third of adults hospitalized with first ACS were identified as high-risk.
- Only one-fifth of high-risk adults were taking statins at the time of hospitalization.
- Our study suggests both poor prediction and poor implementation of guidelines.

ObjectiveTo assess recommended and actual use of statins in primary prevention of cardiovascular disease (CVD) based on clinical prediction scores in adults who develop their first acute coronary syndrome (ACS).MethodCross-sectional study of 3172 adults without previous CVD hospitalized with ACS at 4 university centers in Switzerland. The number of participants eligible for statins before hospitalization was estimated based on the European Society of Cardiology (ESC) guidelines and compared to the observed number of participants on statins at hospital entry.ResultsOverall, 1171 (37%) participants were classified as high-risk (10-year risk of cardiovascular mortality ≥ 5% or diabetes); 1025 (32%) as intermediate risk (10-year risk < 5% but ≥ 1%); and 976 (31%) as low risk (10-year risk < 1%). Before hospitalization, 516 (16%) were on statins; among high-risk participants, only 236 of 1171 (20%) were on statins. If ESC primary prevention guidelines had been fully implemented, an additional 845 high-risk adults (27% of the whole sample) would have been eligible for statins before hospitalization.ConclusionAlthough statins are recommended for primary prevention in high-risk adults, only one-fifth of them are on statins when hospitalized for a first ACS.