Objective: To compare the effects of clopidogrel with or without combined with CYP3A4-metabolized statin in treating coronary artery disease (CAD) among the elderly patients.
Methods: The study cohort was defined as all patients were over 60 years of age and hospitalized for CAD who were prescribed clopidogrel between January 2000 and February 2011. A total of 1021 patients were enrolled, with 178 of them prescribed clopidogrel and 843 patients were administrated clopidogrel combined with statins (CYP3A4-metabolized statins 636 and non CYP3A4-metabolized statins 207). The primary endpoint was all cause of death and the second endpoint were non-fatal myocardial infarction (MI), but hospitalized for unstable angina, stroke, transient ischemic attack, or repeated revascularization (PCI or coronary artery bypass graft).
Results: Among the clopidogrel group and the clopidogrel plus statins group, the incidence density of death was 6.86/1000 and 3.18/1000 respectively, with crude RR as 2.15 (95%CI: 1.39-3.33) and statistically significant (χ2=3.53, P<0.01). The incidence density of composite thromboembolic events did not show statistical significance (P>0.05). The two groups were 1:1 matched, after propensity score matching, clopidogrel coadministrated with statins group showed significant decrease in all cause of death, with RR as 0.42 (95%CI: 0.19-0.93), χ2=7.23, P<0.01. No significant difference was observed in deaths or composite thromboembolic events between statins via different cytochrome P450 pathways.
Conclusion: Clopidogrel with statin could reduce the mortality of elderly CAD patients compared with clopidogrel without statin. The result did not show statistical significance between CYP3A4-metabolized statins or non CYP3A4-metabolized statins regarding the mortality or composite endpoint events.