Early statin use and cardiovascular outcomes after myocardial infarction: A population-based case-control study

BACKGROUND AND AIMS: Statin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). However, many patients do not use statins. We studied the association of not using statin early after MI with adverse outcomes. METHODS: Consecutive MI patients admitted to 20 Finnish hospitals (n = 64,401; median age 71) were retrospectively studied. Statin was not used by 17.1% within 90 days after MI discharge (exposure). Differences in baseline features, comorbidities, revascularization, and other evidence-based medications were balanced with propensity score matching, resulting in 10,051 pairs of patients with and without statin. Median follow-up was 5.9 years. RESULTS: Patients not using statin early after MI had higher all-cause mortality in 1-year (15.8% vs. 11.9%; HR 1.38; CI 1.30-1.46; p < 0.0001) and 10-year follow-up (71.1% vs. 65.2%; HR 1.34; CI 1.30-1.39; p < 0.0001) in the matched cohort. The number needed to harm by not using statin was 24.1 at 1-year and 9.5 at 10-years. The cumulative incidence of major adverse cardiovascular event was higher at 1- and 10-years in matched patients not using statins (sHR 1.15; p < 0.0001 for both). Cardiovascular death, new MI, and ischemic stroke were more frequent without early statin. A lack of statin was associated with outcomes regardless of sex, age, atrial fibrillation, dementia, diabetes, heart failure, revascularization, or usage of other evidence-based secondary preventive medications in subgroup analyses. CONCLUSIONS: Lack of statin therapy early after MI is associated with adverse outcomes across the spectrum of MI patients. Results underline the importance of timely statin use after MI.