title: Selective prescribing led to overestimation of the benefits of lipid-lowering drugs.
abstract: OBJECTIVE
  Observational studies have found beneficial effects of lipid-lowering drugs on diverse outcomes, including venous thromboembolism, hip fracture, dementia, and all-cause mortality. Selective use of these drugs in frail people may confound these relationships.
  
  
  METHODS
  We measured 1-year mortality in two cohorts of New Jersey residents, aged 65-99 years, enrolled in state-sponsored drug benefits programs: 112,463 persons hospitalized during the years 1991-1994 and 106,838 nonhospitalized enrollees. Use of lipid-lowering drugs and other medications, as well as diagnoses, were evaluated before follow-up.
  
  
  RESULTS
  In age- and sex-adjusted analyses, users of lipid-lowering drugs had a 43% reduced death rate relative to nonusers among hospitalized enrollees and a 56% reduction in the nonhospitalized sample. Available markers of frailty and comorbidity predicted decreased use of these drugs. Control for the propensity to use lipid-lowering drugs attenuated but did not eliminate these effects. After such adjustment, users had a 30% reduction in death rate (95% confidence interval [CI]: 25%-35%) among hospitalized enrollees and a 41% reduction (95% CI: 35%-47%) in the nonhospitalized sample. Unmeasured frailty associated with a 26%-33% reduced odds of receiving lipid-lowering therapy could explain this effect.
  
  
  CONCLUSIONS
  Frailty and comorbidity that influence use of preventive therapies can substantially confound apparent benefits of lipid-lowering drugs on outcomes.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02120, USA. rglynn@rics.bwh.harvard.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wang
authors.forename: Raia
authors.initials: R
authors.lastname: Levin
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D002423:Cause of Death; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000401:mortality; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D009515:New Jersey / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000960:Hypolipidemic Agents