Different patterns of statin use in patients with acute myocardial infarction
Stella S Daskalopoulou, Robert J Doonan, Joseph A Delaney
1FRSQ Chercheur-Boursier Clinicien, Assistant Professor in Medicine, Department of Medicine, Division of Internal Medicine, McGill University, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, B2.101.4, Montreal, Quebec, Canada H3G 1A4. stella.daskalopoulou@mcgill.ca.
Insights
Discontinuing statin therapy after acute myocardial infarction (AMI) increases 1-year mortality. Patients who stopped statins post-AMI faced higher risks, highlighting the importance of continued statin use.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Statins are crucial for cardiovascular health.
- Evidence indicates harm from statin discontinuation post-acute myocardial infarction (AMI).
Purpose of the Study:
- To evaluate the association between statin discontinuation after AMI and 1-year all-cause mortality in a real-world setting.
Main Methods:
- Retrospective analysis of AMI survivors (2000-2007) using Quebec healthcare databases.
- Cohort defined by statin prescription filling pre- and post-AMI: non-users, starters, stoppers, and continuous users.
- Cox proportional hazards models used to determine mortality risk.
Main Results:
- Statin stoppers (pre-AMI but not post-AMI) showed a significant increase in 1-year all-cause mortality (adjusted HR 1.36).
- Statin starters and continuous users had significantly lower 1-year mortality compared to non-users (HR 0.65 and 0.81, respectively).
Conclusions:
- Statin discontinuation in AMI survivors is linked to increased 1-year all-cause mortality.
- Physicians should exercise caution when considering statin cessation post-AMI.
Background/Objective:
Statins have well-established cardiovascular benefits, and recent evidence suggests that discontinuing statin therapy after acute myocardial infarction (AMI) is harmful. Our objective was to assess the association between statin discontinuation post-AMI and 1-year all-cause mortality in a real world setting.
Methods:
Data on survivors of AMI between 2000 and 2007 were extracted from the hospital discharge summary database of Quebec and the provincial physician and drug claims database. Statin prescription filling was used to establish cohort groups. Previous statin use was defined as having filled a statin prescription in the 90 days pre-AMI, while post-AMI statin use was filling a prescription between discharge from hospital post-AMI and 90 days post-discharge. AMI patients who survived 90 days (n=48,229) were divided into 4 groups: i) non-users (n=11,657), did not receive statins pre- or post- AMI (reference group), ii) starters (n=22,452), received statins only post-AMI, iii) stoppers (n=488), received statins pre- but not post-AMI, and, iv) users (n=13,632), received statins pre- and post-AMI. Cox proportional hazards models were used to calculate hazard ratios (HR).
Results:
Compared with non-users, stoppers had increased 1-year all-cause mortality (adjusted HR 1.36; 95% CI 1.08- 1.70, P=0.008). Starters (HR 0.65; 95% CI 0.59-0.71, P<0.0001) and users (HR 0.81; 95% CI 0.74-0.88, P<0.0001) had lower mortality than non-users.
Conclusion:
Discontinuation of statins in survivors of AMI was associated with an increase in 1-year all-cause mortality. Physicians should use caution when discontinuing statins post-AMI.
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