Statin usage and all-cause and disease-specific mortality in a nationwide study

Context The consumption of statins (HMG-CoA reductase inhibitors) in most Western countries has increased to the extent that it may affect all-cause and disease-specific mortality. Objective To analyze the association of statin use with all-cause and disease-specific mortality utilizing nationwide databases in a record linkage study in Finland. Methods The study population included all statin users in Finland who had purchased at least one prescription between 1997 and 2005. A control population matched for age, sex, and place of residence and without statin usage was selected. The study population consisted of 336 618 pairs of individuals, and the mean length of follow-up was 4.4 years. All-cause mortality and mortality caused by coronary heart disease (CHD), stroke, other circulatory causes, cancer, unnatural causes, and suicide were analyzed. Persistence to treatment was calculated by varying adherence criteria between 20 and 80%. Results We observed association between all-cause, non-CHD and CHD and treatment with statins in statin user group. For CHD mortality, we observed a relationship between the persistence to statin treatment and a decreasing CHD mortality. For each 10% increase in adherence criteria, a 5% (2-8%) decrease in CHD mortality was observed within the range of 20% (RR 0.81, 95% CI 0.32-2.02) to 80% (RR 0.54, 95% CI 0.46-0.64). Conclusion In this nationwide study, long-term use of statins is associated with the reduction in CHD mortality. Copyright (C) 2011 John Wiley & Sons, Ltd.