title: Mortality rate increases steeply with nonadherence to statin therapy in patients with acute coronary syndrome.
abstract: BACKGROUND
  In a prospective cohort of consecutive acute coronary syndrome (ACS) patients, we compared the adherence rate of statin usage and mortality rate during a median follow-up of 23 months.
  
  
  OBJECTIVE
  Adherence to statin therapy after acute coronary syndrome affects mortality rate.
  
  
  METHODS
  We analyzed ACS patients (N = 1969; age, 65.9 ± 11.8 years; female 30.4%) who underwent angiography between March 2006 and March 2008. The postdischarge usage of statins was based on the purchase register of the Social Insurance Institution of Finland. The death rate was verified from Statistics Finland.
  
  
  RESULTS
  At discharge, the rate of statin prescription to patients was 95.4% (n = 1878). When comparing adherent patients (n = 1200; 61.7%), who purchased the medication systematically until the end of the median 23-month follow-up, with nonadherent patients (n = 94; 4.8%), who did not use the medication at all, there was a vast difference in absolute death rate between the groups: 4.9% vs 14.9%, respectively (P < 0.001). We conducted Cox proportional hazards model with ACS type, cerebrovascular attack, diabetes, age, 3-artery disease, and cancer as adjusted confounders. Compared with regular statin users, nonusers were associated with a >2× increased hazard ratio of mortality (hazard ratio: 2.70, 95% confidence interval: 1.49-4.90, P = 0.001).
  
  
  CONCLUSIONS
  Statin medication is essential for discharged ACS patients. They should be strongly encouraged to purchase and use it.
authors.affiliation: Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Allonen
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Maisa
authors.initials: M
authors.lastname: Lokki
authors.forename: Olavi
authors.initials: O
authors.lastname: Parkkonen
authors.forename: Satu
authors.initials: S
authors.lastname: Vaara
authors.forename: Markus
authors.initials: M
authors.lastname: Perola
authors.forename: Tero
authors.initials: T
authors.lastname: Hiekkalinna
authors.forename: Timo E
authors.initials: TE
authors.lastname: Strandberg
authors.forename: Juha
authors.initials: J
authors.lastname: Sinisalo
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D011307:Drug Prescriptions; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors