Association between statin use and cardiovascular mortality decline at the population level in the Netherlands 1994-2010

Background: There is ongoing debate about the determinants of the decline in age-specific cardiovascular mortality that has occurred in many Western countries since 1970. Objectives: We assessed the contribution of statin use to the decline in cardiovascular mortality for the Netherlands over the period 1994-2010. Methods: We used aggregated mortality data from Statistics Netherlands for the Netherlands as a whole with ∼16 million inhabitants and prevalence of drug use in a representative drug dispensing database (iadb.nl) covering ∼ 500,000 persons annually. In the study population aged 50-83 years over the period 1994 to 2010, we assessed the association between prevalence of statin use with mortality rates from acute myocardial infarction (AMI, ICD9-code 410), other ischaemic heart disease (other IHD, ICD9-codes 411-414) and cerebrovascular disease (ICD9-code 430-438) using a generalized linear model. We controlled for age, sex, birth cohort, other cardiovascular drug use, and diabetes. Results: One additional statin user per 100 personyears in a half year period was associated with a decrease of 1.25% (95% CI: 0.93 to 1.53%) in the total number of individuals that would have died because of AMI in the same half year period. Corresponding figures were 0.93% (CI: 0.42 to 1.43%) for other IHD and 1.06% (CI: 0.70 to 1.42%) for cerebrovascular diseases. In absolute numbers, this meant that statin use was associated with a reduction of approximately 110 AMI deaths per 2.4 million person-years exposed to AMI mortality on average throughout the study period. Conclusions: Statin use appeared associated with a decrease in cardiovascular mortality. Despite limitations inherent to ecological studies, the study provides evidence that at the population level lipid-lowering drugs play an important role in decreasing national cardiovascular mortality rates.