cardiovascular diseases are among the leading causes of death worldwide , with more than 2150 deaths each day . many studies have found a direct relationship between levels of low - density lipoprotein ( ldl ) cholesterol ( or total cholesterol ) and the rate of new - onset coronary heart disease ( chd ) in men and women who were initially free of chd . when other risk factors are present , including diabetes and hypertension , this risk increases even more . this has led to large numbers of clinical trials providing strong evidence that chd incidence is reduced in cholesterol - lowering therapy . a meta - analysis involving 10 trials of 79,494 subjects found that statins reduce coronary events , strokes , and all - cause mortality without increasing non - coronary mortality . high cholesterol is one of the major controllable risk factors for coronary heart disease , heart attack , and stroke , consequently increasing the use of statins throughout the years . it is evident that statin use has a clear benefit on stroke and total mortality by greatly reducing cholesterol . despite the positive results linking statin use and reduction in chd , studies have shown poor adherence to these medications . a systematic review and meta - analysis of 22 cohorts determined several sociodemographic , medical , and healthcare utilization characteristics these factors are useful guides for targeting statin adherence interventions , especially since adherence is an essential factor to receiving the full benefits of these medications . although there have been studies identifying predictors of adherence and non - adherence to statins , there is less evidence identifying reliable predictive variables of mortality among new statin users . in particular , the veteran population is of importance due to the prevalence of risk factors within this group . over 90% are male and more than 40% are over 65 years of age , both of which are risk factors of chd - related deaths . this study aims to identify variables in the first year of statin therapy that are predictive of long - term mortality . this retrospective cohort study used data from the veterans affairs facilities within the veterans integrated service network 22 , including sites from loma linda , long beach , los angeles , san diego , and las vegas . data were collected on study subjects identified as new statin users between december 1 , 2006 , and november 30 , 2007 . socioeconomic status was determined by zip code median household income and divided into five quintiles from lowest to highest income . mpr was calculated as the number of days of statin drug supply the patient filled divided by the number of days in the specific time period . inclusion criteria included age 18 years or older , diagnosis of dyslipidemia , new statin user per the dates listed above , enrollment in the va system for at least 2 years before the study period , and eligibility to receive prescription benefits from the va . patients were excluded if they had missing baseline or follow - up body mass index ( bmi ) , ldl , and total cholesterol ( tc ) laboratory data , or if they were missing zip code income data ( figure 1 ) . baseline comparisons between the mortality group and the survival group were performed using t - test and chi - square test . the primary outcome measure of mortality predictors at 6 years follow - up for new statin users were analyzed using a logistic regression model . the independent variables assessed included race , age , ethnicity , bmi , socioeconomic status , ldl outcomes at 1 year , and baseline comorbidities . all analyses were performed using spss version 18 ( spss inc , chicago , il ) . baseline comparisons between the mortality group and the survival group were performed using t - test and chi - square test . the primary outcome measure of mortality predictors at 6 years follow - up for new statin users were analyzed using a logistic regression model . the independent variables assessed included race , age , ethnicity , bmi , socioeconomic status , ldl outcomes at 1 year , and baseline comorbidities . all analyses were performed using spss version 18 ( spss inc , chicago , il ) . there were a total of 7735 patients who met inclusion criteria , and 4566 patients were included in the final analysis after applying the exclusion criteria . patients in the mortality group were older ( p  <  0.001 ) , on more medications ( p  <  0.001 ) , had higher total cholesterol levels ( p    0.001 ) and had higher incidence of hypertension ( p  <  0.001 ) , vascular disease ( p  <  0.001 ) , chronic obstructive pulmonary disease ( p  =  0.001 ) , congestive heart failure ( p  <  0.001 ) , history of myocardial infarction ( p  <  0.001 ) , and angina ( p  =  0.008 ) . patients in the survival group were more likely to be hispanic ( p  <  0.001 ) , with higher bmi ( p  <  0.001 ) and ldl cholesterol ( p  < 0.001 ) ( table 1 ) . age , medication count , ethnicity , and bmi were predictors of long - term mortality . in addition , patients with comorbidities such as hypertension ( or  =  1.46 , 95% ci  =  1.081.98 , p  =  0.015 ) , diabetes ( or  =  1.36 , 95% ci  =  1.071.72 , p  =  0.012 ) , tobacco use ( or  =  1.52 , 95% ci  =  1.161.99 , p  =  0.002 ) , copd ( or  =  1.88 , 95% ci  =  1.402.53 , p    0.001 ) , and congestive heart failure ( or  =  1.80 , 95% ci  =  1.232.63 , p  =  0.002 ) all showed an increased risk of mortality . there were no significant associations between mortality and race , ldl outcomes at 1 year , and annual income level , as shown in table 2 . there were a total of 7735 patients who met inclusion criteria , and 4566 patients were included in the final analysis after applying the exclusion criteria . patients in the mortality group were older ( p  <  0.001 ) , on more medications ( p  <  0.001 ) , had higher total cholesterol levels ( p    0.001 ) and had higher incidence of hypertension ( p  <  0.001 ) , vascular disease ( p  <  0.001 ) , chronic obstructive pulmonary disease ( p  =  0.001 ) , congestive heart failure ( p  <  0.001 ) , history of myocardial infarction ( p  <  0.001 ) , and angina ( p  =  0.008 ) . patients in the survival group were more likely to be hispanic ( p  <  0.001 ) , with higher bmi ( p  <  0.001 ) and ldl cholesterol ( p  < age , medication count , ethnicity , and bmi were predictors of long - term mortality . in addition , patients with comorbidities such as hypertension ( or  =  1.46 , 95% ci  =  1.081.98 , p  =  0.015 ) , diabetes ( or  =  1.36 , 95% ci  =  1.071.72 , p  =  0.012 ) , tobacco use ( or  =  1.52 , 95% ci  =  1.161.99 , p  =  0.002 ) , copd ( or  =  1.88 , 95% ci  =  1.402.53 , p    0.001 ) , and congestive heart failure ( or  =  1.80 , 95% ci  =  1.232.63 , p  =  0.002 ) all showed an increased risk of mortality . there were no significant associations between mortality and race , ldl outcomes at 1 year , and annual income level , as shown in table 2 . this study showed that different lipid outcomes after the first year of statin therapy were not indicative of long - term mortality . other significant predictors of mortality in new start statin users were seen after a 6 year follow - up period . age , race , number of medications , comorbidities , and bmi were shown to be predictive of long - term mortality in a veteran population , much of which was expected . statin users in the mortality groups were more likely to be taking more medications , an indicator of their underlying diseases , also predictive of mortality . previous studies have shown a highly significant negative association between statin use and mortality . in an overview of 16 individual trials including 29,000 subjects , patients assigned to statin drugs experienced significant reductions in risks of stroke and total mortality . however , the results of our study showed that actual differences in ldl levels at a given point in time among statin users appeared to confer no predictive effect on long - term mortality outcomes . patient stratification between high potent ( rosuvastatin and atorvastatin ) vs non - potent statins did not affect the outcome . sub - groups including hdl , tg , and tc further showed no predictive value of long - term mortality . statin doses and whether the treatment goal of ldl was attained at 1 year follow - up were not assessed in this study . the study by blackburn et al . reported a detectable excess of cardiovascular morbidity associated with non - adherence to statin therapy . numerous other studies have shown that a reduction in ldl is associated with a decreased risk in cardiovascular events and total mortality . these findings suggest that occurrences of cardiovascular events can be prevented with improvements in maintaining adherence in statin users . although our analysis showed no significant difference in adherence as a predictor of long - term mortality , it should be mentioned that cardiovascular outcomes were not assessed . in addition , ldl values in both survival and mortality groups suggest uncontrolled ldl levels at 1 year follow - up , which may be due to the low adherence rates to statin therapy in both groups . therefore , risk factors for cardiovascular events and total mortality including male gender , older age , vascular disease , copd , hypertension , and diabetes took the lead in the risk factor evaluation in the multiple regression analysis , despite the great differences in their baseline rates . in addition , some degree of time immortal bias may be present because no patient s died in the first year ( as per inclusion criteria requiring ldl outcomes at 1 year ) . in addition , follow - up ldl outcomes were performed after 1 year only , extrapolation of values beyond that time point are not possible . the study was performed in a veteran population primarily comprised of male patients , limiting generalizability of the analysis . although this group is of particular interest when looking at the risk factors associated with coronary heart disease , associations between lipid variables and mortality in a broader patient population may vary . in addition , homeless veterans without a zip code were excluded from this study . according to the annual homeless assessment report ( ahar ) to congress from the us department of housing and urban development , there were an estimated 75,609 homeless veterans on a single night in the us in 2009 . the exclusion of this population omitted patients with significant health risks not accounted for in this study . while many studies have examined the risks and benefits between statin and non - statin users , this study attempts to recognize the predictors of mortality in new start statin users . multiple independent variables have been identified as predictors of mortality in statin users after a 6 year follow - up . different lipid outcomes after the first year of statin therapy were not indicative of long - term mortality . future studies should further assess optimal lipid - lowering therapies in the veteran population , especially in the later stages of life to improve clinical outcomes . skaggs school of pharmacy and pharmaceutical sciences provided funding for the research assistant , as part of their summer research internship program . declaration of financial / other interests the authors have no relevant financial or other relationships to disclose . jda peer reviewers on this manuscript have received an honorarium from jda for their review work , but have no other relevant financial relationships to disclose . skaggs school of pharmacy and pharmaceutical sciences provided funding for the research assistant , as part of their summer research internship program . declaration of financial / other interests the authors have no relevant financial or other relationships to disclose . jda peer reviewers on this manuscript have received an honorarium from jda for their review work , but have no other relevant financial relationships to disclose .