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Statin discontinuation detrimental to post-MI survival
5 September 2008
MedWire News: Patients who discontinue use of statins after suffering an acute myocardial infarction (MI) may be increasing their risk for dying, suggests an analysis of the UK General Practice Research Database (GPRD).
"This may represent a biologic rebound or/and a risk-treatment mismatch phenomenon, where treatment is withdrawn from very ill patients," say Stella Daskalopoulou (McGill University, Montreal, Quebec, Canada) and colleagues.
As reported in the European Heart Journal, the team identified 9939 patients in the GPRD who survived for at least 90 days after an MI. Of these, 20% were taking a statin at the time of MI, 21% were not, 57% initiated statin therapy after their MI, and 1.4% stopped taking statins.
Compared with patients not taking statins either before or after MI, statin users and starters had respective nonsignificant 16% and 28% reductions in the risk for dying within 1 year of MI.
But patients who stopped statin therapy had a significant 88% increase in 1-year death risk, after accounting for confounders including post-MI medications.
Stopping aspirin, beta blockers, or proton pump inhibitors after MI did not significantly influence patients' survival.
Editorialists Christopher Heeschen (Ludwig Maximilian University, Munich, Germany) and colleagues said that use of the GPRD "sets the present study apart from previous studies, which were primarily based on subgroup analyses of multicenter trials and their rather selected populations."
They said that although the study was nonrandomized and observational, the results "are of particular scientific value because of the relatively long follow-up period and the much more general approach."
The team added: "Although the results of the present study are still inherently more hypothesis-generating than hypothesis-proving, they provide strong, additional evidence for the detrimental effect of statin withdrawal in patients with acute coronary syndromes."
Heeschen et al therefore concluded: "The continuation of statin therapy following onset of acute coronary syndromes is crucial and is probably most important in patients at high cardiovascular risk."
