Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials.
OBJECTIVE
To compare the social and demographic profiles of patients who receive statin treatment after myocardial infarction and patients included in randomised trials. To estimate the effect of statin use in community based patients on subsequent all cause mortality and cardiovascular recurrence, contrasting effects with trial patients.


METHODS
Observational cohort study using a record linkage database.


METHODS
Tayside, Scotland (population size and characteristics: about 400,000, mixed urban and rural).


METHODS
4892 patients were discharged from hospital after their first myocardial infarction between January 1993 and December 2001. 2463 (50.3%) were taking statins during an average follow-up of 3.7 years (3.1% in 1993 and 62.9% in 2001).


METHODS
All cause mortality and recurrence of cardiovascular events.


RESULTS
319 deaths occurred in the statin treated group (age adjusted rate 4.1 per 100 person years, 95% confidence interval 3.2 to 4.9), and 1200 in the statin untreated group (12.7 per 100 person years, 11.1 to 14.3). More older people and women were represented in the population of patients treated with statins than among those recruited into clinical trials (mean age 67.8 v 59.8; women 39.6% v 16.9%, respectively). The effects of statins in routine clinical practice were consistent with, and similar to, those reported in clinical trials (adjusted hazard ratio for all cause mortality 0.69, 95% confidence interval 0.59 to 0.80; adjusted hazard ratio for cardiovascular recurrence 0.82, 0.71 to 0.95).


CONCLUSIONS
The community effectiveness of statins in those groups that were not well represented in clinical trials was similar to the efficacy of statins in these trials.
Wei
Li
L
Medicines Monitoring Unit, Health Informatics Centre, Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee DD1 9SY.
Ebrahim
Shah
S
Bartlett
Christopher
C
Davey
Peter D
PD
Sullivan
Frank M
FM
MacDonald
Thomas M
TM
D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D055502:Secondary Prevention; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors