Drug Utilization of Statin Therapy in Patients with Acute Coronary Syndrome at the Cardiology and Cardiovascular Outpatient Clinic of Airlangga University Hospital
DOI:
https://doi.org/10.58344/ihj.v5i3.921Keywords:
Acute Coronary Syndrome, Statin, LDL-C, Drug-Related Problems, Secondary PreventionAbstract
Acute coronary syndrome (ACS) remains a major cause of cardiovascular morbidity and mortality, and intensive low-density lipoprotein cholesterol (LDL-C) reduction with high-intensity statin therapy is essential for secondary prevention. This study aimed to evaluate statin utilization, treatment appropriateness, drug-related problems, and LDL-C target attainment among patients with ACS. A retrospective observational study was conducted at the Cardiology and Cardiovascular Outpatient Clinic of Universitas Airlangga Hospital, Surabaya, Indonesia. Medical records of patients treated from July to December 2023 were reviewed, and 51 eligible patients receiving statin therapy were included using total sampling. Data were analyzed descriptively. Moderate-intensity statins predominated; simvastatin 20 mg was the most frequently prescribed statin during the first month, whereas atorvastatin 20 mg predominated during the second month, while atorvastatin 40 mg use remained limited. Inappropriate statin therapy was identified in 45 patients (88.24%), including inadequate statin intensity and insufficient treatment duration. Only two patients (3.9%) achieved the recommended LDL-C target of ?55 mg/dL, both after receiving atorvastatin 40 mg. Suspected statin-associated muscle symptoms occurred in four patients (7.84%), while several potential drug–drug interactions were documented. These findings demonstrated that statin therapy for secondary prevention remained suboptimal, highlighting the need for guideline-concordant prescribing, regular LDL-C monitoring, and systematic management of identified drug-related problems.
References
Aryan, L., Younessi, D., Zargari, M., Banerjee, S., Agopian, J., Rahman, S., Borna, R., Ruffenach, G., Umar, S., & Eghbali, M. (2020). The role of estrogen receptors in cardiovascular disease. International Journal of Molecular Sciences, 21(12). https://doi.org/10.3390/ijms21124314
Ashraf, J., Ali Khan, M., Minhaj, S., Khatti, S., Aarij, K. M., Shehzad, M., & Khan, T. M. (2020). Statins and abnormal liver function tests: Is there a correlation? Cureus, 12(8). https://doi.org/10.7759/cureus.10145
Backes, J. M., Ruisinger, J. F., Gibson, C. A., & Moriarty, P. M. (2017). Statin-associated muscle symptoms and statin intolerance. Journal of Clinical Lipidology, 11. https://doi.org/10.1016/j.jacl.2017.01.006
Bakti, A. N. (2023). Gambaran Penggunaan Simvastatin aan Atorvastatin Pada Pasien Jantung Koroner di RSUD Drs. Saydiman Magetan. Acta Holistica Pharmaciana, 5(1). https://doi.org/10.62857/ahp.v5i1.121
Banach, M., Rizzo, M., & Toth, P. P. (2015). Statin intolerance - an attempt at a unified definition. Position paper from an International Lipid Expert Panel. Archives of Medical Science, 11. https://doi.org/10.5114/aoms.2015.49807
Bansilal, S., Castellano, J. M., Garrido, E., Wei, H. G., Freeman, A., Spettell, C., Garcia-Alonso, F., Lizano, I., Arnold, R. J. G., Rajda, J., Steinberg, G., & Fuster, V. (2016). Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes. Journal of the American College of Cardiology, 68(8). https://doi.org/10.1016/j.jacc.2016.06.005
Björnsson, E. S. (2017). Hepatotoxicity of statins and other lipid-lowering agents. In Liver International (Vol. 37, Number 2). https://doi.org/10.1111/liv.13308
Bouitbir, J., Sanvee, G. M., Panajatovic, M. V., Singh, F., & Krähenbühl, S. (2020). Mechanisms of statin-associated skeletal muscle-associated symptoms. In Pharmacological Research (Vol. 154). https://doi.org/10.1016/j.phrs.2019.03.010
Byrne, R. A., Rossello, X., Coughlan, J. J., & Barbato, E. (2023). 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal, 44(38), 3720–3826. https://doi.org/10.1093/eurheartj/ehad191
Cannon, C. P., De Lemos, J. A., Rosenson, R. S., Ballantyne, C. M., Liu, Y., Gao, Q., Palagashvilli, T., Alam, S., Mues, K. E., Bhatt, D. L., & Kosiborod, M. N. (2021). Use of Lipid-Lowering Therapies over 2 Years in GOULD, a Registry of Patients with Atherosclerotic Cardiovascular Disease in the US. JAMA Cardiology, 6(9). https://doi.org/10.1001/jamacardio.2021.1810
Christiano, N. R., Purwanto, S., & Amriel, E. E. Y. (2023). The Effect of Perceived Price and Facilities on Customer Satisfaction at Soedirman Guest House Tulungagung. Journal of Social Research, 2(8). https://doi.org/10.55324/josr.v2i8.1340
Correction to: 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (Circulation. (2019) 139 (e1082-e1143) DOI: 10.1161/CIR.0000000000000625). (2019). In Circulation (Vol. 139, Number 25). https://doi.org/10.1161/CIR.0000000000000698
Crea, F., & Libby, P. (2017). Acute coronary syndromes: The way forward from mechanisms to precision treatment. Circulation, 136(12). https://doi.org/10.1161/CIRCULATIONAHA.117.029870
Heiran, A., K, B. L., Bradley, R., Simab, A., & Pasalar, M. (2022). Efficacy of herbal treatments for functional dyspepsia: a systematic review and meta-analysis of randomized clinical trials. Phytotherapy Research, 36(2), 686–704.
Huang, W., Tiksnadi, B. B., & Huda, F. (2024). Prescription patterns and their appropriateness within guidelines in chronic coronary syndrome patients. Journal of Applied Pharmaceutical Science, 14(4), 115–124. https://doi.org/10.7324/JAPS.2024.159200
Kakara, M., Nomura, H., Fukae, M., Gotanda, K., Hirota, T., Matsubayashi, S., Shimomura, H., Hirakawa, M., & Ieiri, I. (2014). Population pharmacodynamic analysis of LDL-cholesterol lowering effects by statins and co-medications based on electronic medical records. British Journal of Clinical Pharmacology, 78(4). https://doi.org/10.1111/bcp.12405
Kumar, R., Shaikh, A. H., Kumar, A., Solangi, B. A., Naseer, A. Bin, Awan, R., Chachar, K., Talpur, M. F. H., Saghir, T., Sial, J. A., Qamar, N., Karim, M., & Hakeem, A. (2023). Age and gender-based categorization of very premature, premature, and non-premature acute myocardial infarction: A comparison of clinical and angiographic profile and in-hospital outcomes. International Journal of Cardiology, 391. https://doi.org/10.1016/j.ijcard.2023.131292
Maron, D. J., Newman, J. D., Anthopolos, R., Lu, Y., Stevens, S., Boden, W. E., Mavromatis, K., Linefsky, J., Nair, R. G., Bockeria, O., Gosselin, G., Perna, G. P., Demchenko, E., Foo, D., Shapiro, M. D., Champagne, M. A., Ballantyne, C., McCullough, P., Lopez-Sendon, J. L., … Hochman, J. S. (2025). Guideline-Directed Medical Therapy and Outcomes in the ISCHEMIA Trial. Journal of the American College of Cardiology, 85(12). https://doi.org/10.1016/j.jacc.2025.01.028
Navar, A. M., Wang, T. Y., Li, S., Robinson, J. G., Goldberg, A. C., Virani, S., Roger, V. L., Wilson, P. W. F., Elassal, J., Lee, L. V., & Peterson, E. D. (2017). Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry. American Heart Journal, 193. https://doi.org/10.1016/j.ahj.2017.08.005
Wiggins, B. S., Saseen, J. J., Page, R. L., Reed, B. N., Sneed, K., Kostis, J. B., Lanfear, D., Virani, S., & Morris, P. B. (2016). Recommendations for Management of Clinically Significant Drug-Drug Interactions with Statins and Select Agents Used in Patients with Cardiovascular Disease: A Scientific Statement from the American Heart Association. Circulation, 134(21). https://doi.org/10.1161/CIR.0000000000000456
Wiklund, O., Pirazzi, C., & Romeo, S. (2013). Monitoring of lipids, enzymes, and creatine kinase in patients on lipid-lowering drug therapy. Current Cardiology Reports, 15(9). https://doi.org/10.1007/s11886-013-0397-8
Xavier, D., Gupta, R., Kamath, D., Sigamani, A., Devereaux, P. J., George, N., Joshi, R., Pogue, J., Pais, P., & Yusuf, S. (2016). Community health worker-based intervention for adherence to drugs and lifestyle change after acute coronary syndrome: A multicentre, open, randomised controlled trial. The Lancet Diabetes and Endocrinology, 4(3). https://doi.org/10.1016/S2213-8587(15)00480-5
Zhou, Y. T., Yu, L. S., Zeng, S., Huang, Y. W., Xu, H. M., & Zhou, Q. (2014). Pharmacokinetic drug-drug interactions between 1,4-dihydropyridine calcium channel blockers and statins: Factors determining interaction strength and relevant clinical risk management. In Therapeutics and Clinical Risk Management (Vol. 10, Number 1). https://doi.org/10.2147/TCRM.S55512
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Eunike Christiane Hartanto, Deny Wilson Amanda Sitorus, Wenny Putri Nilamsari, Budi Susetyo Pikir, Marcha Debby Saraswati

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.




