OBJECTIVES: To assess the impact of real life statin utilization on the risk of first non-fatal myocardial infarction (MI). METHODS: Design: Case-control methodology using the pharmacoepidemiological information system “PGRx”. Data on comorbidities, risk factors and medications were obtained from medical records and patient telephone interviews. Setting: General practices (n=371) and cardiology centres (n=60) across France. Participants: Cases were patients with the first MI ≤ 1 month before the date of recruitment (n=2238). Controls were patients seen by a general practitioner (GP) with no restriction as to the reasons of consultation (n=2238), matched to MI cases on gender, age, frequency of visits to a doctor, date of recruitment and personal history of non-cardiovascular chronic disease. Exposure: Statin exposure was defined as any utilisation in the two-year prior to date of MI in cases or recruitment date in controls. Main outcome measures: Adjusted odds ratios (OR) of the risk of first MI was estimated by multiple conditional logistic regression models. Comparative effectiveness and propensity to use of individual statin molecules were assessed. RESULTS: The use of statins was associated with a lower MI risk, with adjusted OR 0.67 [95% CI 0.56 - 0.79] for current use (within 2 months before the index date) and 0.73 [0.62 –0.86] for any use within 24 months. Among individual statins, rosuvastatin was associated with the lowest MI risk (adjusted OR 0.49 [0.35 - 0.68] for any use in 24 months preceding the index date) followed by simvastatin (0.62 [0.46 - 0.84]) and others. CONCLUSIONS: This is the first major population-based field study to investigate the effect of statins on the risk of first non-fatal MI in a real life situation. We observed similar risk reduction as in recent meta-analyses. While most individual statin molecules displayed protective effect, their effectiveness varied depending on patient profile and treatment patterns.