CMAJ • January 30, 2007; 176 (3). doi:10.1503/cmaj.060627.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Research

Sex differences in the effectiveness of statins after myocardial infarction

Igor Karp, Shun-Fu Chen and Louise Pilote

From the Divisions of Clinical Epidemiology (Karp, Chen, Pilote) and Internal Medicine (Pilote), McGill University Health Centre, Montréal, Que.

Correspondence to: Dr. Louise Pilote, Division of Internal Medicine, Royal Victoria Hospital, 687 Pine Ave. W, Rm. A4.21, Montréal QC H3A 1A1; fax 514 934-8293; louise.pilote{at}mcgill.ca

Background: We sought to investigate the sex differences in the effectiveness of statins in patients with acute myocardial infarction (AMI).

Methods: Linking hospital discharge and drug claims databases from Quebec, Canada (1998–2004), we identified statin users (n = 14 710) and non-users (n = 23 833) discharged from hospital after an AMI-related hospital stay and followed up for as long as 7 years.

Results: All-cause death rates were 4.1 and 14.6 per 100 person-years among users and non-users, respectively, whereas cardiac death rates were 2.2 and 7.4 per 100 person-years. For death from any cause, the adjusted hazard ratios associated with statin use in women were 0.61 (95% confidence interval [CI], 0.54–0.69) within 1 year of follow-up, 0.55 (0.48–0.63) at 1–3 years and 0.38 (0.31–0.49) at > 3 years; in men, the corresponding estimates were 0.54 (0.48–0.60), 0.48 (0.42–0.55) and 0.34 (0.30–0.39). For cardiac-related death, the adjusted hazard ratios associated with statin use in women were 0.70 (0.60–0.81) within 1 year, 0.56 (0.46–0.68) at 1–3 years and 0.44 (0.31–0.62) at > 3 years of follow-up, whereas in men, the estimates were 0.59 (0.51–0.69), 0.47 (0.39–0.58) and 0.37 (0.30–0.45), respectively.

Interpretation: Statin therapy after an AMI was associated with reduced rates of all-cause and cardiac mortality. The effect increased with time in both sexes, but the degree of risk reduction was less for women than for men.


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