Background: In clinical trials, cholesterol-lowering medications have been proven to decrease mortality and morbidity and are strongly recommended as secondary prevention in patients with established coronary artery disease. In routine practice, the translation of these benefits to elderly patients with recent coronary revascularization is less well known.
Methods: Using the provincial computerized administrative databases of the Régie de l'Assurance Maladie du Québec, we identified all elderly patients (>65 years old) in Quebec, Canada, discharged alive after a coronary revascularization procedure (percutaneous coronary intervention or coronary artery bypass graft) between April 1, 1995, and December 31, 1997, and determined the percentage fulfilling prescriptions for cholesterol-lowering drug therapy. Time-dependent multivariable models examined the clinical end points of total mortality, acute myocardial infarctions, and repeat coronary revascularizations as a function of cholesterol-lowering drug exposure. Patients were followed up until death or December 31, 1999.
Results: We identified 11958 elderly patients who had a coronary revascularization between April 1, 1995, and December 31, 1997. During an average 3-year follow-up, users of cholesterol-lowering medications had a decreased risk of death [hazard ratio (HR) 0.66, 95% CI 0.45-0.96] or myocardial infarction (HR 0.77, 95% CI 0.54-1.11) but no reduction in repeat revascularizations (HR 1.06, 95% CI 0.88-1.28).
Conclusions: In this population-based study of recently revascularized elderly patients, we observed health benefits associated with the use of cholesterol-lowering medications of similar size to those seen in randomized clinical trials. The translation of these benefits from clinical trials to a nonselected population of revascularized patients emphasizes the importance of this aspect of secondary prevention in clinical practice.