TY - JOUR T1 - Statins are associated with a large reduction in all-cause mortality in women from a cardiac outpatient population JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2021-001900 VL - 9 IS - 1 SP - e001900 AU - Sophie H Bots AU - N Charlotte Onland-Moret AU - Milena Jancev AU - Monika Hollander AU - Igor I Tulevski AU - Leonard Hofstra AU - G Aernoud Somsen AU - Hester M den Ruijter Y1 - 2022/04/01 UR - http://openheart.bmj.com/content/9/1/e001900.abstract N2 - Objectives Uncertainty about the benefit of (high-intensity) statins for women remains due to under-representation of women in primary prevention trials and scarcity of sex-stratified data. This study evaluates the sex-specific relation between statin treatment and survival and the additional benefit of high-intensity statins.Methods Electronic health record data from 47 801 patients (17 008 statin users and 30 793 non-users) without prior cardiovascular disease were extracted from thirteen Dutch outpatient cardiology clinics. Patients prescribed statins at baseline were propensity-score matched to those eligible for statin therapy (low-density lipoprotein >2.5 mmol/L) without a statin prescription. Statins were divided into low-intensity and high-intensity according to Dutch guidelines. Mortality data were obtained via linkage to the national mortality registry. Cox regression was used to evaluate the relationship between statin prescription and intensity and all-cause and cardiovascular mortality.Results Propensity score matching created a cohort of 8631 statin users and 8631 non-users. 35% of women and 28% of men received a low-intensity statin. The beneficial effect of statins on both all-cause and cardiovascular mortality was stronger in women (HR 0.66, 95% CI 0.58 to 0.74 and HR 0.55, 95% CI 0.39 to 0.71, respectively) than in men (HR 0.89, 95% CI 0.81 to 0.95 and HR 0.93, 95% CI 0.77 to 1.08, respectively). High-intensity statins conferred modest protection against all-cause mortality (HR 0.94, 95% CI 0.88 to 1.00) and cardiovascular mortality (HR 0.86, 95% CI 0.74 to 0.98) in both sexes.Conclusions The protective effect of primary prevention statins was stronger in women than men for both all-cause and cardiovascular mortality. High-intensity statins conferred a modest additional benefit in both sexes. Statins seem to be effective regardless of treatment intensity, especially in women.No data are available. All data are stored within the UMC infrastructure and cannot be made publicly available due to privacy constraints. The survival follow-up data obtained via record linkage with Statistics Netherlands are not publicly available and cannot be accessed by researchers not registered on the project. ER -