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Vol. 72. Issue 1.
Pages 98 (January 2019)
Letter to the Editor
DOI: 10.1016/j.rec.2018.08.006
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Use of High-potency Statins After Percutaneous Revascularization
Uso de estatinas de alta potencia tras revascularización percutánea
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Mercedes Millán Gómeza,
Corresponding author
mercedesmillang@gmail.com

Corresponding author:
, Macarena Cano Garcíab, Carlos Sánchez Gonzálezb, Manuel Jiménez Navarroa
a Unidad de Gestión Clínica, Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
b Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
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Rev Esp Cardiol. 2018;71:416-710.1016/j.rec.2017.09.016
Kinjan H. Parikh, Ajay J. Kirtane
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To the Editor,

We have read with interest the editorial by Parikh and Kirtane1 on the indication for higher-intensity lipid-lowering therapy after drug-eluting stent implantation. Statins reduce the risk of atherosclerotic cardiovascular disease and improve prognosis after acute coronary syndrome. The effectiveness of the therapy has been linked to the magnitude of the drug-induced reduction in low-density lipoproteins. Thus, high-potency statins provide an even greater benefit than lower-potency statins.2

Our group recently compared the percutaneous revascularization strategy for severe lesions in secondary coronary branches (diameter ≥ 2mm) of major epicardial arteries vs conservative treatment in 589 patients.3 After a mean follow-up of 24 months, there were no significant differences in the occurrence of cardiovascular events between percutaneous treatment (376 patients, 63.8%) and conservative treatment (213 patients, 36.2%).

We also analyzed whether the use of high-potency statins (atorvastatin, rosuvastatin, pitavastatin, and simvastatin 80mg) vs low-potency statins differed according to the revascularization strategy adopted. None of the patients–neither overall nor when stratified according to the treatment received–showed differences in cardiovascular events during follow-up according to whether they received percutaneous revascularization or optimal medical therapy.

We believe that 2 important aspects should be considered by researchers evaluating the benefit of the use of high-potency statins after percutaneous revascularization. The first is the possible prescription bias that leads physicians to prescribe more intensive treatments after stenting vs optimal medical treatment.4 The second aspect is the greater adherence to lipid-lowering therapy in patients receiving percutaneous treatment vs those who do not.5

References
[1]
K.H. Parikh, A.J. Kirtane.
Should we up the intensity of statin therapy after placing a drug-eluting stent?.
Rev Esp Cardiol., 71 (2018), pp. 416-417
[2]
M.F. Jiménez Navarro.
Comments on the 2016 ESC Guidelines on cardiovascular disease prevention in clinical practice.
Rev Esp Cardiol., 69 (2016), pp. 894-899
[3]
M. Cano-García, M. Millán-Gómez, C. Sánchez-González, et al.
Impact of percutaneous coronary revascularization of severe coronary lesions on secondary branches.
[4]
A.J. Bagnall, A.T. Yan, R.T. Yan, et al.
Optimal medical therapy for non-ST-segment-elevation acute coronary syndromes: exploring why physicians do not prescribe evidence-based treatment and why patients discontinue medications after discharge.
Circ Cardiovasc Qual Outcomes., 3 (2010), pp. 530-537
[5]
C. Kocas, O. Abaci, V. Oktay, et al.
Percutaneous coronary intervention vs. optimal medical therapy--the other side of the coin: medication adherence.
J Clin Pharm Ther., 38 (2013), pp. 476-479
Copyright © 2018. Sociedad Española de Cardiología
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