Socioeconomic and ethnic differences in use of lipid-lowering drugs after deregulation of simvastatin in the UK: The Whitehall II prospective cohort study

Abstract

BackgroundWe examined socioeconomic and ethnic differences in use of lipid-lowering drugs after deregulation of simvastatin in the UK for adults with moderate or high risk of coronary heart disease. Methods3631 participants in the Whitehall II cohort study (mean age 62.7years, 91% white) were informed of their risk of coronary heart disease, based on Framingham score, before deregulation (2002–2004). The use of prescribed lipid-lowering drugs and use of over-the-counter simvastatin were analysed as outcome variables, after deregulation (2005–2007). Results2451 participants were at high risk and 1180 at moderate risk. 20% moderate-risk and 44% high-risk participants reported using prescribed lipid-lowering drugs although no over-the-counter simvastatin was used. Prescribing rates did not differ between employment grades (an index of socioeconomic position), but was higher among South Asian high-risk compared with White high-risk participants (odds ratio 1.64, 95% CI 1.21–2.23). Of the high-risk participants, 44% recalled their increased coronary heart disease risk. South Asian high-risk participants were less likely to recall than White high-risk participants (odds ratio 0.65, 95% CI 0.46–0.93). Furthermore, high risk participants with middle (odds ratio 0.74, 95% CI 0.61–0.89) and low (odds ratio 0.52, 95% CI 0.37–0.74) employment grades were less likely to recall than those with high grades. ConclusionSocioeconomic and ethnic differences in reported use of lipid-lowering drugs were small, but the use of these drugs in general was much lower than recommended and the participants did not utilise over-the-counter statins. Ethnic minorities and lower socioeconomic position groups were less likely to be aware of their increased coronary risk.