Abstract
BackgroundThe current study evaluated time trends of statin use and incidence of recurrent CVD in secondary prevention from 1999 to 2013 and investigated which factors were associated with statin use in secondary prevention.MethodsIntego is a primary care registration network with 111 general practitioners working in 48 practices in Flanders, Belgium. This retrospective registry-based study included patients aged 50 years or older with a history of CVD. The time trends of statin use and incidence of recurrent CVD in secondary prevention were determined by using a joinpoint regression analysis. Multivariable mixed-effect logistic regression analysis was used to assess factors associated with statin use in patients in secondary prevention in 2013.ResultsThe overall prevalence of statin use increased and showed two trends: a sharp increase from 1999 to 2005 (annual percentage change (APC) 25.4%) and a weaker increase from 2005 to 2013 (APC 3.7%). The average increase in statin use was the highest in patients aged 80 and older. Patients aged 70–79 years received the most statins. Men used more statins than women did, but both genders showed similar time trends. The incidence of CVD decreased by an average APC of 3.9%. There were no differences between men and women and between different age groups. A significant decrease was only observed in older patients without statins prescribed. In 2013, 61% of the patients in secondary prevention did not receive a statin. The absence of other secondary preventive medication was strongly associated with less statin use. Gender, age and comorbidity were associated with statin use to a lesser degree.ConclusionsThe prevalence of statin use in secondary prevention increased strongly from 1999 to 2013. Less than 50% of patients with a history of CVD received a statin in 2013. Especially patients who did not receive other secondary preventive medication were more likely to not receive a statin. Despite the strong increase in statin use, there was only a small decrease in the incidence of recurrent CVD, and this occurred mainly in older patients without statins prescribed.
Highlights
Cardiovascular diseases (CVD) are still the leading cause of death in Europe: in 2012 they were responsible for 47% of all deaths [1, 2]
Statin non-use is very prevalent, the current study hypothesized that the use of statins in secondary prevention has increased substantially and that this possibly coincides with a lower incidence of recurrent CVD
Men used more statins in secondary prevention than women did, but the time trends were similar in both genders (AAPC 12.3% and 12.6%, respectively, annual percentage change (AAPC) difference − 0.3%)
Summary
Cardiovascular diseases (CVD) are still the leading cause of death in Europe: in 2012 they were responsible for 47% of all deaths [1, 2]. To date, no study described time trends of statin use in secondary prevention in combination with the evolution of recurrent CVD in the general population. Statin non-use is very prevalent, the current study hypothesized that the use of statins in secondary prevention has increased substantially and that this possibly coincides with a lower incidence of recurrent CVD. Factors associated with less statin use such as female gender, older age, comorbidity (diabetes, heart failure), smoking, low cholesterol level, longer time after diagnosis and type of CVD have been described [9, 10, 12, 15, 23, 26, 32,33,34,35,36]. The current study evaluated time trends of statin use and incidence of recurrent CVD in secondary prevention from 1999 to 2013 and investigated which factors were associated with statin use in secondary prevention
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