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No connection between the level of exposition to statins in the population and the incidence/mortality of acute myocardial infarction: An ecological study based on Sweden’s municipalities
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, East County Primary Health Care.
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Unit of R&D in Primary Care, Jönköping, Sweden .
Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden .
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2011 (English)In: Journal of Negative Results in Biomedicine, ISSN 1477-5751, E-ISSN 1475-9306, Vol. 10, no 6Article in journal (Refereed) Published
Abstract [en]

Background

Randomised controlled trials have shown an excellent preventive effect of statins on ischemic heart disease. Our objective was to investigate if a relation can be detected between acute myocardial infarction- (AMI) mortality or incidence and statin utilisation, for men and women in different age-groups on a population basis.

Results

The utilisation rate of statins increased almost three times for both men and women between 1998 and 2002. During 1998-2000 the incidence of AMI decreased clearly for men but only slightly for women. Mortality decreased from 1998 to 2002. The change in statin utilisation from 1998 to 2000 showed no correlation to the change in AMI mortality from 2000 to 2002. Statin utilisation and AMI- incidence or mortality showed no correlations when adjusting for socio-economic deprivation, antidiabetic drugs and geographic coordinates.

Conclusions

Despite a widespread and increasing utilisation of statins, no correlation to the incidence or mortality of AMI could be detected. Other factors than increased statin treatment should be analysed especially when discussing the allocation of public resources.

Place, publisher, year, edition, pages
2011. Vol. 10, no 6
Keyword [en]
Myocardial infarction, Incidence, Antilipemic agents, Sweden; Population, Ecological study
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13085DOI: 10.1186/1477-5751-10-6OAI: oai:DiVA.org:liu-13085DiVA: diva2:17796
Note

On the day of the defence day the status of this article was: Submitted

Available from: 2008-03-25 Created: 2008-03-25 Last updated: 2014-09-23
In thesis
1. Chest pain and ischemic heart disease: Diagnosis and management in primary health care
Open this publication in new window or tab >>Chest pain and ischemic heart disease: Diagnosis and management in primary health care
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims. In patients consulting for chest pain, it is of great importance to evaluate the possibility of ischemic heart disease (IHD). The aims in this thesis were to investigate the accuracy of the general practitioners’ clinical assessments and the applicability of exercise testing and myocardial perfusion scintigraphy (MPS) in patients consulting for chest pain in primary care.

Statins are known to prevent IHD. A further aim was therefore to investigate if a relation could be detected on a population basis between the use of statins and the morbidity of acute myocardial infarction (AMI).

Methods. All patients from 20 to 79 years, consulting for a new episode of chest pain in three primary health care centres, were included during almost two years from 1998 to 2000. The patients were managed according to the clinical evaluation. The presence of IHD was excluded either by clinical examination only, or if stable IHD was in question, by exercise testing and if the exercise test was inconclusive by an additional MPS. If unstable IHD or myocardial infarction was suspected, referral for emergency hospital examination was made.

Correlations between statin sales and the morbidity of AMI in Sweden’s municipalities were analysed in an ecological, register based study. Adjustment was made for sales of antidiabetics, socio-economic deprivation indexes and geographic coordinates.

Results. Consultations for chest pain represented 1.5% of all consultations in the ages 20 to 79 and were made by 554 patients. In 281 patients IHD was excluded by clinical examination only. In 208 patients stable IHD and in 65 unstable IHD was in question. Four patients (1.4%) evaluated as not having IHD, were diagnosed with angina pectoris or AMI within three months. Exercise testing was performed in 191 patients and revealed no IHD in 134 and IHD in 14 patients. In 43 patients the exercise test results were equivocal. Thirty-nine of these patients underwent MPS, which showed no IHD in 20 and IHD in 19 of the patients.

In a follow up almost six years later, neither mortality rate nor prevalence of IHD differed significantly between the 384 study patients evaluated not to have IHD and the population controls.

Statin sales and AMI-incidence or mortality showed no strong associations from 1998 to 2002.

Conclusions.

·Primary care is an appropriate level of care for ruling out IHD as the cause of chest pain, with sufficient safety and for diagnostics of stable IHD.

·Exercise testing and myocardial perfusion scintigraphy are useful procedures when investigating chest pain patients in primary care.

·The results indicate that preventive measures other than increased statin treatment should be considered to further decrease AMI-morbidity.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2008. 253 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1039
Keyword
Chest pain, ischemic heart disease, primary health care, diagnosis, lipid lowering drugs
National Category
Clinical Science
Identifiers
urn:nbn:se:liu:diva-11390 (URN)978-91-7393-987-4 (ISBN)
Public defence
2008-04-11, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-03-25 Created: 2008-03-25 Last updated: 2009-08-21

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Nilsson, StaffanMölstad, Sigvard

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