Penning-van Beest FJA et al. (2007) Adherence to evidence-based statin guidelines reduces the risk of hospitalizations for acute myocardial infarction by 40%: a cohort study. Eur Heart J 28: 154–159

Clinical trials indicate that robust statin therapy can reduce serum cholesterol levels effectively; however, 'real world' use of statins seems to be suboptimal for the prevention of adverse cardiovascular outcomes. In this cohort study, Penning-van Beest et al. have investigated the effects of statin dose and nonpersistent use on the risk of hospitalization for acute myocardial infarction (AMI).

Analysis of the Dutch PHARMO database identified 59,094 new users of statins in the period 1991–2004 who met all inclusion criteria. Statin exposure for each patient was determined for the first 2 years of treatment, after which time they were followed for the end points of death, first hospitalization for AMI or study end. Patients who used statins persistently for 2 years (n = 27,537) exhibited a 30% reduction in the risk of hospitalization for AMI compared with nonpersistent users (<18 months continuous use). This reduction in risk was greatest in those patients receiving high doses of potent statins (equipotency score ≥4; relative risk 0.62). These findings indicate that statin use in daily practice might be suboptimal, and that increased doses, for longer periods of time, should be considered.

The authors particularly recommend the use of newer more-potent statins, such as atorvastatin and rosuvastatin, over first-generation drugs, and suggest that the use of cheaper, older agents (as encouraged in Germany and The Netherlands) might be a false economy.