The use of statin drug therapy for primary prevention of cardiovascular disease in primary care: a retrospective cohort study

Moffatt, Amelia (2016) The use of statin drug therapy for primary prevention of cardiovascular disease in primary care: a retrospective cohort study. Masters thesis, Memorial University of Newfoundland.

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Abstract

Statin drugs have been widely studied for their efficacy in secondary prevention by preventing the recurrence of cardiovascular disease (CVD), however their use as a primary prevention strategy in individuals without documented CVD, especially at low risk, is highly controversial among the medical community. The current research study used data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN); a database that houses point-of-care data from physician electronic medical records (EMR) from primary care practices all across Canada. It is a valuable resource to conduct outcomes research on diseases and conditions managed in primary care. This retrospective inception cohort study assessed whether statin drug use over a period of five years (January 1, 2009 to December 31, 2013) reduced outcomes of CVD and all-cause mortality in a group of primary prevention patients (i.e. patients who have never had CVD) from Newfoundland and Labrador (NL). The CPCSSN database was linked to both the Clinical Database Management System and Mortality Registry housed at the Newfoundland and Labrador Center for Health Information (NLCHI). The results based on univariate analysis suggested that statin drug use was associated with increased rates of CVD, hospitalization and coronary artery disease (CAD). However, these apparent harmful effects of statins in causing CVD were no longer present when other risk factors of CVD (sex, age, BMI, LDL-C, HDL-C, HTN, smoking status, total cholesterol, total triglycerides and blood pressure) were controlled for using logistic regression. Statin drugs were also significantly associated with decreased rates of all-cause mortality, and this beneficial effect persisted after controlling for CVD risk factors. Our results also demonstrated that statins were significantly associated with an increase in diabetes mellitus (DM) over the study period. The results obtained were similar when we considered compliance and used only those in the exposure group who had used statins for ≥ 80% of the five year follow up period. The use of statin drugs in a primary prevention situation is still controversial, and the results of this study provide real world data from EMR practices in NL on the effects of statins on CVD outcomes and death. This study concludes that at best, statins had no effect on CVD outcomes but decreased all-cause mortality. The results of a “real-life” assessment of the benefits of using statins in a primary prevention situation are not nearly as impressive as what clinical trials suggest.

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