Scenario
Sam is a 60-year-old male heart attack survivor who had an unremarkable recovery after the successful coronary artery stenting in the middle of the night of his presentation. Now it is 3 months and Sam feels absolutely grand. At follow-up, his cardiologist insists that he should continue all the prescribed medications. He read on the internet some bad press about statin medications and thought, “surely, nothing will happen if I stop taking statins?!”
Discussion
As cardiologists, we all believe that the statin beneficial effects are indisputable. A lot of the evidence has been based on randomised controlled trials based on highly selected trial patients. And for this reason, the lack of real-life data is sometimes suggested as a weakness in such argument.
A Danish nationwide prospective cohort study was recently published in the European Heart Journal. This study is unique in that it followed the entire Danish population from 1995 to 2010. This is real-life data, including everyone over 40 years of age who were initiated on statin therapy, totalling 674 900 individuals.
Two important take home messages from the study (and therefore applicable for Sam in the above scnaerio) were:
1. Early statin discontinuation was associated with myocardial infarction and death, with a hazard ratio of 1.26 and 1.18 respectively. In plain English, those who stopped taking a statin early early on were 26% more likely to have an MI and 18% more likely to die, during follow-up.
2. Early statin discontinuation was quite significantly influenced by negative news stories. Many of these negative news stories were based on hearsay criticisms of poor-quality reports. Clinicians continue to have a central role of debunking the “statin myth”.
The technical details of the paper are as below:
Early statin discontinuation was positively associated with these factors:
1.09 (1.06–1.12) for negative statin-related news stories,
1.04 (1.02 – 1.07) per increasing calendar year,
1.04 (1.02 – 1.06) per increasing defined daily dose of statin,
1.05 (1.03 – 1.06) for male sex,
1.13 (1.11 – 1.15) for living in cities,
1.67 (1.63 – 1.71) for other ethnicity than Danish,
Early statin discontinuation was positively associated with these factors:
0.92 (0.90–0.94) for positive statin-related news stories,
0.73 (0.72–0.74) for baseline cardiovascular disease,
0.91 (0.90–0.93) for baseline diabetes
(odds ratio; 95% confidence interval)
Reference
Nielsen SF, Nordestgaard BG. Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study. Eur Heart J. 2015 Dec 1. PMID: 26643266
Author
Dr Andrew To