Statins use for primary prevention of cardiovascular disease: A population-based digitally enabled real-world evidence cross-sectional study in primary care in Brazil

Abstract

BACKGROUNDStatins consist of the main strategy to reduce dyslipidemia-related cardiovascular risk. Nevertheless, there is scarce evidence on the real-world statins use in primary care settings in low-middle-income countries. OBJECTIVEWe conducted a cross-sectional retrospective study using anonymized data routinely collected by community health workers in Brazil aimed to evaluate statin use and associated factors in a primary prevention population with cardiovascular risk enhancers. METHODSStudy population consisted of adults with hypertension, diabetes and/or dyslipidemia. The primary and secondary outcomes were the proportion of individuals self-reporting statins use on any dose, and high-dose statins/high-intensity lipid lowering therapy (LLT) respectively. RESULTSOf the 2,133,900 adult individuals on the database, 415,766 (19.5%) were included in the study cohort. From this cohort, 89.1% had hypertension, 28.9% diabetes and 5.5% dyslipidemia. The mean age was 61.5 (SD 14.5) years, 63.4% were female and 61.0% were of mixed-race. Only 2.6% and 0.1% of individuals self-reported the use of statins and high-dose statins/high-intensity LLT, respectively. Older age (OR 1.96; 95% CI 1.88,2.05;p < 0.001), living in the South region of Brazil (OR 4.39; 95%CI 3.97,4.85,p < 0.001), heart failure (OR 2.60; 95%CI 2.33,2.89,p < 0.001), chronic kidney disease (OR 1.49; 95%CI 1.35,1.64,p < 0.001) and anti-hypertensive medications use (OR 4.38; 95%CI 4.07,4.71,p < 0.001) were independently associated with statin use. CONCLUSIONIn a real-world evidence study analyzing data routinely collected in a digitized primary care setting, we observed a very low use of statins in a primary prevention population with cardiovascular risk enhancers in Brazil. Socio-demographic factors and co-morbidities were associated to higher statins use rates.