Statin use for primary prevention of cardiovascular disease among apparently healthy adults

OBJECTIVE: To study the association between statin adherence and the 5-year risk of major cardiovascular events among apparently healthy individuals.

METHODS AND RESULTS: A nationwide cohort study utilising national registries in Denmark was conducted. All apparently healthy individuals aged 40-85 years using statins for one year between 1997 and 2022 with no personal history of cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, hepatic diseases, cancer, or parents with cardiovascular disease, among other exclusion factors, were included. Statin use was categorized according to adherence by the proportion of days covered with redeemed statin prescriptions: <50% (low), 50-75% (moderate), and 75-100% (high). The primary outcome was a composite of myocardial infarction, stroke, or cardiovascular death. The 5-year absolute risk was estimated using the Aalen-Johansen estimator while considering competing risks. Additionally, cause-specific Cox proportional hazards models were used to estimate hazard ratios across statin adherence levels.Among 151,791 apparently healthy individuals, low statin adherence was associated with a 5-year major cardiovascular risk of 4.77% (95%-confidence interval 4.18-5.36). For moderate adherence, the 5-year risk was 3.71% (95%-confidence interval 4.18-5.36), and the corresponding hazard ratio was 0.87 (95%-confidence interval 0.75-1.01), while high adherence was associated with the lowest 5-year risk of 3.01% (95%-confidence interval 2.90-3.11), and the corresponding hazard ratio was 0.66 (95%-confidence interval 0.58-0.75).

CONCLUSION: High statin adherence among apparently healthy users was associated with a significant risk reduction of major cardiovascular adverse events.