title: Survival Benefits of Statins for Primary Prevention: A Cohort Study.
abstract: OBJECTIVE
  Estimate the effect of statin prescription on mortality in the population of England and Wales with no previous history of cardiovascular disease.
  
  
  METHODS
  Primary care records from The Health Improvement Network 1987-2011 were used. Four cohorts of participants aged 60, 65, 70, or 75 years at baseline included 118,700, 199,574, 247,149, and 194,085 participants; and 1.4, 1.9, 1.8, and 1.1 million person-years of data, respectively. The exposure was any statin prescription at any time before the participant reached the baseline age (60, 65, 70 or 75) and the outcome was all-cause mortality at any age above the baseline age. The hazard of mortality associated with statin prescription was calculated by Cox's proportional hazard regressions, adjusted for sex, year of birth, socioeconomic status, diabetes, antihypertensive medication, hypercholesterolaemia, body mass index, smoking status, and general practice. Participants were grouped by QRISK2 baseline risk of a first cardiovascular event in the next ten years of <10%, 10-19%, or ≥20%.
  
  
  RESULTS
  There was no reduction in all-cause mortality for statin prescription initiated in participants with a QRISK2 score <10% at any baseline age, or in participants aged 60 at baseline in any risk group. Mortality was lower in participants with a QRISK2 score ≥20% if statin prescription had been initiated by age 65 (adjusted hazard ratio (HR) 0.86 (0.79-0.94)), 70 (HR 0.83 (0.79-0.88)), or 75 (HR 0.82 (0.79-0.86)). Mortality reduction was uncertain with a QRISK2 score of 10-19%: the HR was 1.00 (0.91-1.11) for statin prescription by age 65, 0.89 (0.81-0.99) by age 70, or 0.79 (0.52-1.19) by age 75.
  
  
  CONCLUSIONS
  The current internationally recommended thresholds for statin therapy for primary prevention of cardiovascular disease in routine practice may be too low and may lead to overtreatment of younger people and those at low risk.
authors.affiliation: School of Computing Sciences, University of East Anglia, Norwich, United Kingdom.
authors.forename: Lisanne A
authors.initials: LA
authors.lastname: Gitsels
authors.affiliation: School of Computing Sciences, University of East Anglia, Norwich, United Kingdom.
authors.forename: Elena
authors.initials: E
authors.lastname: Kulinskaya
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Steel
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011322:Primary Prevention; D016016:Proportional Hazards Models; D062486:Public Health Surveillance; D012307:Risk Factors; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors