• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (40)  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in this journal  Topic Collections  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Drug Therapy  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

A Population-Based Cohort Study

Varda Shalev, MD; Gabriel Chodick, PhD; Haim Silber, MD; Ehud Kokia, MD; Joseph Jan, MHA; Anthony D. Heymann, MD

Arch Intern Med. 2009;169(3):260-268.

Background  The beneficial effects of statins on cardiovascular mortality in secondary prevention have been established in several long-term, placebo-controlled trials. However, the value of statin therapy in reduction of overall mortality in patients without coronary heart disease (CHD) is questionable. This study evaluated the effect of statin therapy in subjects with no indication of cardiovascular disease (primary prevention) and patients with known CHD (secondary prevention).

Methods  This retrospective cohort study included 229 918 adult enrollees in a health maintenance organization in Israel who initiated statin treatment from 1998 through 2006 (mean age, 57.6 years; 50.8% female). Proportion of days covered (PDC) with statins was measured by the number of dispensed statin prescriptions during the interval between the date of the first statin prescription and the end of follow-up.

Results  During a mean of 4.0 and 5.0 years of follow-up, there were 4259 and 8906 deaths among the primary prevention and secondary prevention cohorts, respectively. In both cohorts, continuity of treatment with statins (PDC, 90%) conferred at least a 45% reduction in risk of death compared with patients with a PDC of less than 10%. A stronger risk reduction was calculated among patients with high baseline low-density lipoprotein cholesterol level and patients initially treated with high-efficacy statins.

Conclusions  Better continuity of statin treatment provided an ongoing reduction in mortality among patients with and without a known history of CHD. The observed benefits from statins were greater than expected from randomized clinical trials.

Author Affiliations: Medical Division, Maccabi Healthcare Services (Drs Shalev, Chodick, Silber, Kokia, and Heymann and Mr Jan), and Sackler Faculty of Medicine, Tel Aviv University (Drs Shalev, Chodick, and Heymann), Tel Aviv, Israel.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Association Not Causation
Beatrice A. Golomb and Sabrina Koperski
Arch Intern Med. 2009;169(11):1079.
EXTRACT | FULL TEXT  

Continuation of Statin Treatment and Mortality: A Note of Caution on Excessive Benefits
Kristian B. Filion, Verena Schneider-Lindner, Igor Karp, Linda E. Lévesque, James M. Brophy, and Samy Suissa
Arch Intern Med. 2009;169(11):1080.
EXTRACT | FULL TEXT  

Continuation of Statin Treatment and Mortality: A Note of Caution on Excessive Benefits—Reply
Varda Shalev and Gabriel Chodick
Arch Intern Med. 2009;169(11):1080-1081.
EXTRACT | FULL TEXT  

The Healthy Adherer Effect
Frank Andersohn and Stefan N. Willich
Arch Intern Med. 2009;169(17):1635-1636.
EXTRACT | FULL TEXT  

The Healthy Adherer Effect—Reply
Varda Shalev and Gabriel Chodick
Arch Intern Med. 2009;169(17):1636.
EXTRACT | FULL TEXT  

RELATED ARTICLE

In This Issue of Archives of Internal Medicine
Arch Intern Med. 2009;169(3):216.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Overestimation of the effects of adherence on outcomes: a case study in healthy user bias and hypertension
LaFleur et al.
Heart 2011;97:1862-1869.
ABSTRACT | FULL TEXT  

Strategies to improve drug adherence
Laufs et al.
Eur Heart J 2011;32:264-268.
FULL TEXT  

Feeling Vigorous and the Risks of All-Cause Mortality, Ischemic Heart Disease, and Diabetes: A 20-Year Follow-up of Healthy Employees
Shirom et al.
Psychosom. Med. 2010;72:727-733.
ABSTRACT | FULL TEXT  

Lovastatin Interacts with Natural Products to Influence Cultured Hepatocarcinoma Cell (Hep-G2) Growth
Popovich et al.
J. Am. Coll. Nutr. 2010;29:204-210.
ABSTRACT | FULL TEXT  

Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database
Hippisley-Cox and Coupland
BMJ 2010;340:c2197-c2197.
ABSTRACT | FULL TEXT  

The Year in Epidemiology, Health Services Research, and Outcomes Research
Hlatky and Heidenreich
J Am Coll Cardiol 2009;54:2343-2351.
FULL TEXT  

Value-Driven Spine Care
Nash
American Journal of Medical Quality 2009;24:3S-3S.
 

The Healthy Adherer Effect
Andersohn and Willich
Arch Intern Med 2009;169:1635-1636.
FULL TEXT  

Continuation of Statin Treatment and Mortality: A Note of Caution on Excessive Benefits
Filion et al.
Arch Intern Med 2009;169:1080-1080.
FULL TEXT  

Association Not Causation
Golomb and Koperski
Arch Intern Med 2009;169:1079-1079.
FULL TEXT  

Continuation of Statin Treatment and Mortality: A Note of Caution on Excessive Benefits--Reply
Shalev and Chodick
Arch Intern Med 2009;169:1080-1081.
FULL TEXT