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

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.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.The premature mortality of cardiovascular disease has been declining the last decades in Sweden as well as in many other countries. This is true regarding acute myocardial infarction (AMI) as well, according to nation wide Swedish statistics of AMI covering the period from 1987 to present [1]. On a population basis, a previous study reported a possible negative correlation between the utilisation of lipid lowering drugs and death in ischemic heart disease 1989 - 1993 in Swedish municipalities [2].During recent years, the statin utilisation has continued to increase and reliable AMI incidence data on a municipality level has become available [3]. Randomised controlled trials have shown unequivocal benefits of statin treatment [4-6]. A detectable relation between statin utilisation and AMI incidence/mortality on a population basis should be of great interest for decisions about allocation of preventive resources.The aim of this study was to evaluate if there exists an ecological correlation between AMI mortality/incidence and statin utilisation for men and women in different age groups in Sweden's municipalities.The study included 289 of 290 Swedish municipalities. One municipality was excluded d