Class effects of statins in elderly patients with congestive heart failure: A population-based analysis
Received 20 April 2007; accepted 13 September 2007. published online 26 October 2007.
Background
Long-term treatment with statins reduces mortality in patients with congestive heart failure (CHF). Whether statin agents exert a class effect is unknown.
Methods
We analyzed long-term mortality in Canadian patients aged ≥65 years who were discharged from hospital with a diagnosis of CHF from January 1998 to December 2002. Administrative data from Quebec, Ontario, and British Columbia were merged. We compared patients prescribed with atorvastatin, simvastatin, pravastatin, and lovastatin.
Results
A total of 15368 patients hospitalized with a diagnosis of CHF fulfilled the inclusion criteria for this study. In this final dataset, 6670 (43.4%) filled a prescription for atorvastatin, 4261 (27.7%) for simvastatin, 3209 (20.9%) for pravastatin, and 1228 (8.0%) for lovastatin. Clinical characteristics and proportion of days covered with a statin prescription were similar across groups. Drug dosages were relatively low, with 82% of patients who received the agent at a dose of ≤20 mg. Although controlling for time-dependent covariates representing current use and dosage, as well as for age, sex, coronary artery disease, and several other comorbidities, treatment with pravastatin (adjusted hazards ratio [HR] 0.94, 95% CI 0.83-1.07), lovastatin (adjusted HR 1.02, 95% CI 0.88-1.17), or simvastatin (adjusted HR 0.92, 95% CI 0.83-1.01) had a similar effectiveness to prevent mortality compared to atorvastatin (reference in this analysis) in this population with CHF. Time-dependent exposure to a statin was highly protective against mortality.
Conclusions
Statins exert a class effect in patients with CHF, when used at a relatively low dose. The favorable effects appear largely independent of drug dosage.
aDivision of Cardiology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
bDivision of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, Canada
cDivision of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
dDivision of Clinical Epidemiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
eDivision of Cardiology, University of British Columbia and Centre for Health Evaluation and Outcome Science, Vancouver, British Columbia
fInstitute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
gDivision of Internal Medicine, McGill University Health Center, McGill University, Montreal, Canada
Reprint requests: Louise Pilote, MD, MPH, PhD, Division of Internal Medicine and Clinical Epidemiology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4.
Supported by grants from the Canadian Institutes of Health Research (#MOP53181, MOP19671).
ABSTRACT