Temporal Trends, Underuse, and Multilevel Factors Associated With Maximum-Dose Statin Therapy in Acute and Chronic Coronary Syndromes ― A Nationwide JROAD-DPC Study ―
Abstract
BACKGROUND: High-intensity or maximally tolerated statin therapy has robust evidence for secondary prevention in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS), and is strongly recommended in international guidelines. However, comprehensive real-world data on its use and associated factors remain limited. METHODS AND RESULTS: Using data from the JROAD-DPC database (2017-2022), we analyzed ACS and CCS patients who underwent revascularization and were discharged alive. We assessed temporal trends in lipid-lowering therapy and examined associated factors, including patient demographics, comorbidities, treatment strategies, and hospital structural characteristics, using multivariable mixed-effects logistic regression models. Among 358,570 patients with ACS and 392,821 with CCS, the use of maximum-dose statins increased from 8.6% in 2017 to 34.1% in 2022 in ACS and from 7.8% to 19.1% in CCS, but remained suboptimal. After multivariable adjustment, older age, underweight status, and coronary artery bypass grafting were associated with lower use of maximum-dose statins in ACS. In CCS, older age, underweight status, and higher comorbidity burden were associated with lower use of maximum-dose statins. Hospital structural factors, including a higher number of cardiologists, were also associated with a greater use of maximum-dose statins. CONCLUSIONS: Maximum-dose statin use among ACS and CCS patients remains suboptimal in Japan. Multilevel factors contribute to this evidence-practice gap, underscoring the need for comprehensive interventions at multiple levels to reduce disparities in care delivery.
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BibTeX
@article{hayakawa2026temporal,
title = {{Temporal Trends, Underuse, and Multilevel Factors Associated With Maximum-Dose Statin Therapy in Acute and Chronic Coronary Syndromes ― A Nationwide JROAD-DPC Study ―}},
author = {Koji Hayakawa and Kazuhiro Nakao and Yoko M Nakao and Yoko Sumita and Koshiro Kanaoka and Kentaro Mitsui and Kota Murai and Hiroyuki Miura and Masashi Fujino and Makoto Murata and Kensuke Takagi and Shuichi Yoneda and Fumiyuki Otsuka and Yu Kataoka and Yasuhide Asaumi and Yoshihiro Miyamoto and Satoshi Yasuda and Teruo Noguchi},
journal = {Circulation Journal},
year = {2026},
month = oct,
doi = {10.1253/circj.cj-26-0355},
url = {https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0355/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Temporal Trends, Underuse, and Multilevel Factors Associated With Maximum-Dose Statin Therapy in Acute and Chronic Coronary Syndromes ― A Nationwide JROAD-DPC Study ―
AU - Koji Hayakawa
AU - Kazuhiro Nakao
AU - Yoko M Nakao
AU - Yoko Sumita
AU - Koshiro Kanaoka
AU - Kentaro Mitsui
AU - Kota Murai
AU - Hiroyuki Miura
AU - Masashi Fujino
AU - Makoto Murata
AU - Kensuke Takagi
AU - Shuichi Yoneda
AU - Fumiyuki Otsuka
AU - Yu Kataoka
AU - Yasuhide Asaumi
AU - Yoshihiro Miyamoto
AU - Satoshi Yasuda
AU - Teruo Noguchi
PY - 2026
DA - 2026/10/28
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0355
UR - https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0355/_article
AB - BACKGROUND: High-intensity or maximally tolerated statin therapy has robust evidence for secondary prevention in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS), and is strongly recommended in international guidelines. However, comprehensive real-world data on its use and associated factors remain limited. METHODS AND RESULTS: Using data from the JROAD-DPC database (2017-2022), we analyzed ACS and CCS patients who underwent revascularization and were discharged alive. We assessed temporal trends in lipid-lowering therapy and examined associated factors, including patient demographics, comorbidities, treatment strategies, and hospital structural characteristics, using multivariable mixed-effects logistic regression models. Among 358,570 patients with ACS and 392,821 with CCS, the use of maximum-dose statins increased from 8.6% in 2017 to 34.1% in 2022 in ACS and from 7.8% to 19.1% in CCS, but remained suboptimal. After multivariable adjustment, older age, underweight status, and coronary artery bypass grafting were associated with lower use of maximum-dose statins in ACS. In CCS, older age, underweight status, and higher comorbidity burden were associated with lower use of maximum-dose statins. Hospital structural factors, including a higher number of cardiologists, were also associated with a greater use of maximum-dose statins. CONCLUSIONS: Maximum-dose statin use among ACS and CCS patients remains suboptimal in Japan. Multilevel factors contribute to this evidence-practice gap, underscoring the need for comprehensive interventions at multiple levels to reduce disparities in care delivery.
SN - 1347-4820
SN - 1346-9843
ER -