title: Different patterns of statin use in patients with acute myocardial infarction.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.forename: Stella S
authors.initials: SS
authors.lastname: Daskalopoulou
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Doonan
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Delaney
authors.affiliation: FRSQ 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.
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D010351:Patient Discharge / Q000639:trends; D011159:Population Surveillance / Q000379:methods; D015996:Survival Rate / Q000639:trends
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors