Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials

Li Wei, Shah Ebrahim, Christopher Bartlett, Peter D. Davey, Frank M. Sullivan, Thomas M. MacDonald

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    Abstract

    Objective To compare the social and demographic profiles of patients who receive statin treatment after myocardial infarction and patients included in randomised trials. To estimate the effect of statin use in community based patients on subsequent all cause mortality and cardiovascular recurrence, contrasting effects with trial patients. Design Observational cohort study using a record linkage database. Setting Tayside, Scotland (population size and characteristics: about 400 000, mixed urban and rural). Subjects 4892 patients were discharged from hospital after their first myocardial infarction between January 1993 and December 2001. 2463 (50.3%) were taking statins during an average follow-up of 3.7 years (3.1% in 1993 and 62.9% in 2001). Main outcome measures All cause mortality and recurrence of cardiovascular events. Results 319 deaths occurred in the statin treated group (age adjusted rate 4.1 per 100 person years, 95% confidence interval 3.2 to 4.9), and 1200 in the statin untreated group (12.7 per 100 person years, 11.1 to 14.3). More older people and women were represented in the population of patients treated with statins than among those recruited into clinical trials (mean age 67.8 v 59.8; women 39.6% v 16.9%, respectively). The effects of statins in routine clinical practice were consistent with, and similar to, those reported in clinical trials (adjusted hazard ratio for all cause mortality 0.69, 95% confidence interval 0.59 to 0.80; adjusted hazard ratio for cardiovascular recurrence 0.82, 0.71 to 0.95). Conclusions The community effectiveness of statins in those groups that were not well represented in clinical trials was similar to the efficacy of statins in these trials.
    Original languageEnglish
    Pages (from-to)821-824A
    JournalBMJ
    Volume330
    Issue number7495
    DOIs
    Publication statusPublished - 2005

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    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Secondary Prevention
    Coronary Disease
    Primary Health Care
    Cohort Studies
    Clinical Trials
    Recurrence
    Mortality
    Myocardial Infarction
    Confidence Intervals
    Scotland
    Population Characteristics
    Population Density
    Observational Studies
    Age Groups
    Demography
    Outcome Assessment (Health Care)
    Databases

    Cite this

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    title = "Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials",
    abstract = "Objective To compare the social and demographic profiles of patients who receive statin treatment after myocardial infarction and patients included in randomised trials. To estimate the effect of statin use in community based patients on subsequent all cause mortality and cardiovascular recurrence, contrasting effects with trial patients. Design Observational cohort study using a record linkage database. Setting Tayside, Scotland (population size and characteristics: about 400 000, mixed urban and rural). Subjects 4892 patients were discharged from hospital after their first myocardial infarction between January 1993 and December 2001. 2463 (50.3{\%}) were taking statins during an average follow-up of 3.7 years (3.1{\%} in 1993 and 62.9{\%} in 2001). Main outcome measures All cause mortality and recurrence of cardiovascular events. Results 319 deaths occurred in the statin treated group (age adjusted rate 4.1 per 100 person years, 95{\%} confidence interval 3.2 to 4.9), and 1200 in the statin untreated group (12.7 per 100 person years, 11.1 to 14.3). More older people and women were represented in the population of patients treated with statins than among those recruited into clinical trials (mean age 67.8 v 59.8; women 39.6{\%} v 16.9{\%}, respectively). The effects of statins in routine clinical practice were consistent with, and similar to, those reported in clinical trials (adjusted hazard ratio for all cause mortality 0.69, 95{\%} confidence interval 0.59 to 0.80; adjusted hazard ratio for cardiovascular recurrence 0.82, 0.71 to 0.95). Conclusions The community effectiveness of statins in those groups that were not well represented in clinical trials was similar to the efficacy of statins in these trials.",
    author = "Li Wei and Shah Ebrahim and Christopher Bartlett and Davey, {Peter D.} and Sullivan, {Frank M.} and MacDonald, {Thomas M.}",
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    Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials. / Wei, Li; Ebrahim, Shah; Bartlett, Christopher; Davey, Peter D.; Sullivan, Frank M.; MacDonald, Thomas M.

    In: BMJ, Vol. 330, No. 7495, 2005, p. 821-824A.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials

    AU - Wei, Li

    AU - Ebrahim, Shah

    AU - Bartlett, Christopher

    AU - Davey, Peter D.

    AU - Sullivan, Frank M.

    AU - MacDonald, Thomas M.

    N1 - dc.publisher: BMJ Publishing Group

    PY - 2005

    Y1 - 2005

    N2 - Objective To compare the social and demographic profiles of patients who receive statin treatment after myocardial infarction and patients included in randomised trials. To estimate the effect of statin use in community based patients on subsequent all cause mortality and cardiovascular recurrence, contrasting effects with trial patients. Design Observational cohort study using a record linkage database. Setting Tayside, Scotland (population size and characteristics: about 400 000, mixed urban and rural). Subjects 4892 patients were discharged from hospital after their first myocardial infarction between January 1993 and December 2001. 2463 (50.3%) were taking statins during an average follow-up of 3.7 years (3.1% in 1993 and 62.9% in 2001). Main outcome measures All cause mortality and recurrence of cardiovascular events. Results 319 deaths occurred in the statin treated group (age adjusted rate 4.1 per 100 person years, 95% confidence interval 3.2 to 4.9), and 1200 in the statin untreated group (12.7 per 100 person years, 11.1 to 14.3). More older people and women were represented in the population of patients treated with statins than among those recruited into clinical trials (mean age 67.8 v 59.8; women 39.6% v 16.9%, respectively). The effects of statins in routine clinical practice were consistent with, and similar to, those reported in clinical trials (adjusted hazard ratio for all cause mortality 0.69, 95% confidence interval 0.59 to 0.80; adjusted hazard ratio for cardiovascular recurrence 0.82, 0.71 to 0.95). Conclusions The community effectiveness of statins in those groups that were not well represented in clinical trials was similar to the efficacy of statins in these trials.

    AB - Objective To compare the social and demographic profiles of patients who receive statin treatment after myocardial infarction and patients included in randomised trials. To estimate the effect of statin use in community based patients on subsequent all cause mortality and cardiovascular recurrence, contrasting effects with trial patients. Design Observational cohort study using a record linkage database. Setting Tayside, Scotland (population size and characteristics: about 400 000, mixed urban and rural). Subjects 4892 patients were discharged from hospital after their first myocardial infarction between January 1993 and December 2001. 2463 (50.3%) were taking statins during an average follow-up of 3.7 years (3.1% in 1993 and 62.9% in 2001). Main outcome measures All cause mortality and recurrence of cardiovascular events. Results 319 deaths occurred in the statin treated group (age adjusted rate 4.1 per 100 person years, 95% confidence interval 3.2 to 4.9), and 1200 in the statin untreated group (12.7 per 100 person years, 11.1 to 14.3). More older people and women were represented in the population of patients treated with statins than among those recruited into clinical trials (mean age 67.8 v 59.8; women 39.6% v 16.9%, respectively). The effects of statins in routine clinical practice were consistent with, and similar to, those reported in clinical trials (adjusted hazard ratio for all cause mortality 0.69, 95% confidence interval 0.59 to 0.80; adjusted hazard ratio for cardiovascular recurrence 0.82, 0.71 to 0.95). Conclusions The community effectiveness of statins in those groups that were not well represented in clinical trials was similar to the efficacy of statins in these trials.

    U2 - 10.1136/bmj.38398.408032.8F

    DO - 10.1136/bmj.38398.408032.8F

    M3 - Article

    VL - 330

    SP - 821-824A

    JO - British Medical Journal

    JF - British Medical Journal

    SN - 0959-8146

    IS - 7495

    ER -