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Abstract
Objective:
To compare incidences of cardiovascular disease (CVD) in general and myocardial infarction (MI) specifically between new users of different statins in daily practice.
Design and methodology:
Retrospective observational cohort study. Data were obtained from the PHARMO Record Linkage System; the PHARMO database contains pharmacy dispensing records of 3 million patients in the Netherlands registered with community pharmacies, linked to hospitalisation records. The participants were new statin users in the period 2000–2005, excluding patients hospitalised for CVD events in the year prior to start of statin use.
Main outcome measures:
Adjusted hazard ratios of hospitalisations for CVD (including any type of ischemic heart disease, stroke, or revascularisation procedure) in general, or MI in particular, occurring during use of the initial statin within two years of start of therapy, comparing users of different statins.
Results:
The mean follow-up duration of 76,147 new statin users (14,530 pravastatin, 27,752 simvastatin, 25,777 atorvastatin, 8088 rosuvastatin) was 55 weeks. Incidence rates of CVD and MI per 100 person years ranged from 0.75 and 0.15 for rosuvastatin to 1.72 and 0.29 for pravastatin. Rosuvastatin users had a lower incidence rate of CVD compared to other statin users in general (28% lower), and simvastatin (29% lower) and pravastatin users (40% lower) in particular. The difference with atorvastatin was not statistically significant. Since this was not a prospective randomised study, there is the potential for unobserved risk factors to be responsible for some of the differences observed.
Conclusion:
Compared to other statin users without recent prior cardiovascular events, the incidence of fatal and non-fatal CVD in this retrospective observational cohort study was 28% lower among rosuvastatin users.
Transparency
Declaration of funding
AstraZeneca funded the study performed by the PHARMO Institute and the article was written by employees of the PHARMO Institute. The sponsor was involved in conception and design of the study and in critical revision of the manuscript. The researchers from the PHARMO Institute and AS were scientifically independent from the funders.
Declaration of financial/other relationships
The PHARMO Institute is a research institute that performs financially supported studies for several pharmaceutical companies, including AstraZeneca, Pfizer, Merck Sharp & Dohme and Novartis. Employees E.H., F.P. and R.H. have disclosed that they no significant relationships with or financial interests in any commercial companies related to this study or article. S.J. is an employee of and owns stock in AstraZeneca. A.S. has disclosed that he has no relevant financial relationships.
Some peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he is the recipient of grants or research funding from Pfizer, Novartis and Sonexa Therapeutics; that he is a consultant or advisor to Pfizer, Novartis, Sonexa, AFFiRiS, Astellas, Servier, Schering-Plough, Wyeth, Lundbeck, Bristol Myers Squibb and UBC Peer Reviewer 2 has disclosed no relevant financial relationships.
Acknowledgement
We thank Huub Straatman (an employee of the PHARMO Institute) for contributing statistical advice. This article complies with STROBE guidelines.