Statin use and cardiovascular outcomes after myocardial infarction: a population-based case-control study

Abstract

Abstract Background Statin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). However, many patients do not use statins. Purpose To study the impact of not using statin early after MI on adverse outcomes. Methods Consecutive MI patients admitted to 20 Finnish hospitals (n=64,401; median age 71) were retrospectively studied. Statin was not used by 17.1% within 90 days after MI discharge (exposure). Differences in baseline features, comorbidities, revascularization, and other evidence-based medications were balanced with propensity score matching, resulting in 10,051 pairs of patients with and without statin. Median follow-up was 5.9 years. Results High-risk patients used statins less frequently. Patients not using statin early after MI had higher all-cause mortality in 1-year (15.8% vs. 11.9%; HR 1.38; CI 1.30–1.46; p<0.0001) and 10-year follow-up (71.1% vs. 65.2%; HR 1.34; CI 1.30–1.39; p<0.0001). The number needed to harm by not using statin was 24.1 at 1-year and 9.5 at 10-years. The cumulative incidence of major adverse cardiovascular event was higher at 1- and 10-years in patients not using statins (sHR 1.15; p<0.0001 for both). Cardiovascular death, new MI, and ischemic stroke were more frequent without early statin. A lack of statin was associated with outcomes regardless of sex, age, atrial fibrillation, dementia, diabetes, heart failure, revascularization, or usage of other evidence-based secondary preventive medications in subgroup analyses. Conclusions Lack of statin therapy after MI is associated with adverse outcomes across the spectrum of MI patients. Measures to improve timely statin use after MI are still needed. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Finnish Foundation for Cardiovascular Research, Paavo Nurmi Foundation