Time trends in the prescription of statins for the primary prevention of cardiovascular disease in the United Kingdom: a cohort study using The Health Improvement Network primary care data.

Aidan O'Keeffe,Irene Petersen,Irwin Nazareth

doi:10.2147/clep.s104258

Abstract

BackgroundStatins are widely prescribed for the primary prevention of cardiovascular disease. Guidelines exist for statin prescriptions, but there is little recent analysis concerning prescription trends over time and how these vary with respect to demographic variables.Methods and resultsUsing The Health Improvement Network primary care database, statin therapy initiation and statin prescription prevalence rates were calculated using data from 7,027,711 individuals across the UK for the years 1995 to 2013, overall and stratified by sex, age group, and socioeconomic deprivation level (Townsend score). Statin therapy initiation rates rose sharply from 1995 (0.51 per 1,000 person-years) up to 2006 (19.83 per 1,000 person-years) and thereafter declined (10.76 per 1,000 person-years in 2013). Males had higher initiation rates than females and individuals aged 60–85 years had higher initiation rates than younger or more elderly age groups. Initiation rates were slightly higher as social deprivation level increased, after accounting for age and sex. Prescription prevalence increased sharply from 1995 (2.36 per 1,000 person-years) to 2013 (128.03 per 1,000 person-years) with males generally having a higher prevalence rate, over time, than females. Prevalence rates over time were generally higher for older age groups but were similar with respect to social deprivation level.ConclusionThe uptake of statins within UK primary care has increased greatly over time with statins being more commonly prescribed to older patients in general and, in recent years, males appear to have been prescribed statins at higher rates than females. After accounting for age and sex, the statin therapy initiation rate increases with the level of social deprivation.

Highlights

Statins – a large class of cholesterol-lowering drugs – are widely prescribed for the primary prevention of cardiovascular disease (CVD).[1,2] Since the 1990s, a number of clinical trials and large-scale studies have demonstrated the effectiveness of statins for CVD prevention[3,4,5,6] and, in recent years, statins have become one of the most regularly prescribed medicines in the UK.[7]
We attempt a comprehensive, large-scale assessment of prescribing trends for statins over time within the UK. We examine both the rate of statin therapy initiation and the prevalence of statin prescriptions over time for the primary prevention of CVD
The number of patients in each of the Townsend score quintiles 1 to 4 was broadly similar with fewer patients in the most deprived, fifth, Townsend score quintile (Table 1). This distribution is in line with that of Blak et al.30 Overall, statin therapy initiation rates rose at an increasing rate

Summary

Introduction

Statins – a large class of cholesterol-lowering drugs – are widely prescribed for the primary prevention of cardiovascular disease (CVD).[1,2] Since the 1990s, a number of clinical trials and large-scale studies have demonstrated the effectiveness of statins for CVD prevention[3,4,5,6] and, in recent years, statins have become one of the most regularly prescribed medicines in the UK.[7]. Methods and results: Using The Health Improvement Network primary care database, statin therapy initiation and statin prescription prevalence rates were calculated using data from 7,027,711 individuals across the UK for the years 1995 to 2013, overall and stratified by sex, age group, and socioeconomic deprivation level (Townsend score). Prevalence rates over time were generally higher for older age groups but were similar with respect to social deprivation level. Conclusion: The uptake of statins within UK primary care has increased greatly over time with statins being more commonly prescribed to older patients in general and, in recent years, males appear to have been prescribed statins at higher rates than females. After accounting for age and sex, the statin therapy initiation rate increases with the level of social deprivation.

Methods

Results

Conclusion