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Observational Studies of Treatment Effectiveness: Some Cautions

Andreas Laupacis, MD, MSc; and Muhammad Mamdani, PharmD, MA, MPH
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From Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5, Canada.

Potential Financial Conflicts of Interest: None disclosed.

Corresponding Author: Andreas Laupacis, MD, MSc, FRCPC, Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue–G106, Toronto, Ontario M4N 3M5, Canada; e-mail, alaupacis@ices.on.ca.

Current Author Addresses: Drs. Laupacis and Mamdani: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue–G106, Toronto, Ontario M4N 3M5, Canada.

Ann Intern Med. 2004;140(11):923-924. doi:10.7326/0003-4819-140-11-200406010-00014
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The last decade has seen an extraordinary proliferation of evidence that statins decrease mortality in patients who have, or are at risk for developing, cardiovascular disease (12). The benefits extend to high-risk patients with normal cholesterol levels (2) and have led some to suggest that all individuals older than 55 years of age should receive statins as part of a “polypill” (3). In this issue, Spencer and colleagues (4) add to the evidence in favor of statins. They conclude that statin users with an acute coronary syndrome are less likely to present with ST-segment elevation or myocardial infarction than those not receiving statins (odds ratio, 0.78 [95% CI, 0.70 to 0.86]). More surprisingly, they also conclude that starting statin therapy after admission markedly decreases in-hospital mortality (odds ratio, 0.38 [CI, 0.30 to 0.48]).

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