Graded relationship demonstrated between statins' effects on mortality and patients' coronary heart disease risk

According to an observational study recently published in the American Journal of Cardiology, use of a statin was associated with a 46% decrease in patients' odds of death compared with the risk of death in those not receiving a statin, despite the fact that statin users were in general at a higher risk for death. Furthermore, the magnitude of the observed mortality benefit associated with statin use appeared to increase as a patient's number of coronary heart disease risk factors increased.

The authors evaluated nearly 1.5 million veterans using the Veterans Affairs Computerized Patient-Care Review System, a database containing clinical and demographic data on all patients receiving care at 10 medical centers in the South Central Veterans Affairs Healthcare Network.

Of the 1,490,466 patients in this analysis, 228,528 (15.3%) patients received a statin (simvastatin, 77%; lovastatin, 19%; atorvastatin, 3%), and 1,261,938 (84.7%) patients did not. The researchers observed that patients taking a statin were significantly less likely to die than patients not taking a statin (adjusted OR=0.54; 95% CI, 0.42–0.69; P<.0001), even though statin users were older (46.4% were aged ≥70 years) than patients not receiving a statin and had a significantly higher incidence of coronary heart disease risk factors, including smoking; hypertension; diabetes mellitus; prior history of myocardial infarction (MI), angina pectoris, or coronary artery bypass surgery; obesity; and depression. Patients taking a statin also had higher total serum cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglyceride levels than patients not taking a statin. Mean age at death was 2.1 years greater in patients receiving a statin compared with patients not receiving a statin (P<.0001).

The authors emphasized that the study was an important addition to the literature as it demonstrated a graded relationship between risk factors and statins' effects.

SOURCE Mehta JL, Bursac Z, Hauer-Jensen M, Fort C, Fink LM. Comparison of mortality rates in statin users versus nonstatin users in a United States veteran population. Am J Cardiol. 2006;98:923–928.