Increased Use Of Statins Research Articles

Increased statin use after ischemic stroke

Patients who have had ischemic stroke are at increased risk for subsequent cardiovascular disease (CVD). HMG-CoA reductase inhibitors (statins) have been shown to significantly reduce CVD in both primary and secondary prevention studies. The purpose of this study was to determine statin usage at hospital admission and discharge and the frequency of lipid testing in patients who had ischemic strokes. Medical records were retrospectively reviewed for 200 consecutive patients aged ≥18 years with documented first ischemic stroke admitted to Medical University of SC hospital July 2002–June 2004. Of the 200 patients, 107 (54%) were women, 93 (47%) were men, 123 (62%) were African Americans, 75 (38%) were white, 2 (1%) were other race, mean age was 66 ± 13 years, comorbidities included hypertension (183, 92%), diabetes (93, 47%), smoking (65, 33%), prior stroke (51, 26%), coronary artery disease (CAD) (56, 28%), atrial fibrillation (32, 16%), and history of TIA (9, 5%). Seventy-seven patients (39%) were on a statin at admission, with statin users more likely than nonusers to have diabetes (p = .04) or CAD (p = .00). A lipid profile was done on 161 (81%) of the 200 patients during hospitalization. Statin users had a mean admission LDL-C of 106 mg/dl vs. 130 mg/dl not on a statin (p = .00). Of the 54 statin users who had lipids tested, 29 (54%) were at NCEP ATP III goal LDL-C levels. Of the 107 nonstatin users who had lipids tested, 68 (64%) should have been treated based on ATP-III criteria for risk factors and LDL-C level. Of the 186 patients discharged alive, 121 (65%) were discharged on a statin, including 53 of 115 (46%) not on a statin at admission. Independent predictors of being discharged on a statin, if not on a statin at admission, were age < 80 years (p = .01), increasing LDL-C (the higher the more likely to be treated p = .00), and female gender (p = .00). In this group of 200 patients hospitalized for ischemic stroke, 77 (39%) were admitted on a statin, 161 (81%) were tested for lipid values, and 121 of 186 (65%) discharged alive were continued or discharged on a statin. This increased use of statins, relative to admission, should reduce the risk of poststroke cardiovascular events.

Trends in prescribing and utilization of statins and other lipid lowering drugs across Europe 1997–2003

To describe trends in utilization and prescribing of statins and other lipid lowering drugs across Europe from data in routine administrative databases. Observational study in EU member states and Norway. Comparison of annual utilization data for lipid lowering agents by class and drug from national administrative databases for reimbursement over the period 1997-2003, measured in DDDs per 1000 inhabitants/day. Prescribed daily doses (PDD) of statins obtained from a commercial database (IMS Health) for 2000 and 2003, and used to calculate numbers of "patient treatment days" (PTD) in each country in each year. Analysis of PTD to explain increased utilization of statins. Use of lipid lowering agents varied among countries (in 2003, highest in Ireland and Norway, and lowest in Italy), but increased in all countries studied (between 2000 and 2003 by 274% in Ireland and by 56% in France). This increase was entirely due to increases in statin use. Prescribed daily doses of statins increased in all countries for which data was available between 2000 and 2003, but still usually fell below the doses used in the major trials of statins. As a result, the numbers of PTDs increased to a lesser extent than suggested by utilization (e.g. by 192% in Ireland and by 35% in France). One-third of the total rise in utilization was explained by increased PDD, and two-thirds by an increase in numbers of PTDs. Statins dominated the markets in all countries, although fibrates remained strong in France and Belgium (approximately 25% of all lipid lowering agents) and to a lesser extent Germany (10%). Use of statins across Europe has increased hugely over the study period. Some of the increase in use is due to higher prescribed daily doses, but two-thirds is due to increases in numbers of patient days of treatment, either due to more patients treated or less likely to better compliance.

Are patients receiving maximal medical therapy following carotid endarterectomy?

Most patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) did not receive lipid-lowering treatment. As vascular event rates can be lowered with statins, antihypertensive agents, and newer antiplatelet agents, the authors conducted a study to determine the usage of these medications in patients following carotid endarterectomy (CE). Claims data from Blue Cross and Blue Shield Michigan were used to study non-Medicare members who underwent CE in the years 1999 to 2001 (n = 1,049). Prescription of pharmacotherapy and sustained use (>80% use of the follow-up period) were examined in the 365-day period following index CE. Overall, 1,049 individuals underwent CE during the years 1999 to 2001. For the 1-year period following CE, the statin prescription rate was 70, 66, and 73% for the 3 study years. Sustained statin use was noted, on average, in 38%. The 3-year average was lower for sustained use of angiotensin-converting enzyme inhibitor (19%) and even lower for prescription antiplatelet agents (5%). Use of statins has increased following carotid endarterectomy (CE) compared with the North American Symptomatic Carotid Endarterectomy Trial era, but sustained treatment with statins remains at <40%. Recent studies have shown a decrease in vascular event rates with statins regardless of low-density lipoprotein level, suggesting that statin use should be routine following CE. Increased statin use as part of a multimodality intensive medical regimen following CE has the potential to improve long-term vascular event rates in this population.

Variations and increase in use of statins across Europe: data from administrative databases

Coronary heart disease remains a major cause of death in most European countries.1 Statins lower blood cholesterol concentration and reduce the relative risk of coronary events by about 30% in...

Use of the statins in patients after acute myocardial infarction: does evidence change practice?

To compare the use of lipid-lowering agents in 42 628 elderly patients (aged > or =65 years) after acute myocardial infarction, before and after the publication of the Scandinavian Simvastatin Survival Study (4S), using the Ontario Myocardial Infarction Database. Multivariate regression models were created to estimate changes in the rate of statin use over time in monthly cohorts of elderly patients after acute myocardial infarction in Ontario from April 1, 1992, to March 31, 1997. Changes in the rate of statin use over time were estimated using patient and prescriber characteristics. We found a 3.6-fold significant increase in the monthly rate of statin use after the publication of 4S compared with before the publication of 4S (P<.001); specifically, the rate of increase in simvastatin and pravastatin sodium use was higher after the publication of 4S (P<.001 for each). Before the publication of 4S, the rate of increase in statin use in younger patients (aged 65-74 years) was 2.7 times higher than in older patients (aged > or =75 years) (P =.02), while after the publication of 4S, the rate of increase in statin use was only 1.8-fold higher in the younger group (P<.001). After the publication of 4S, there was a 1.6-fold higher rate of increase in statin use in male compared with female patients (P =.006). Also after the publication of 4S, specialists (cardiologists and internists) had a 2-fold higher rate of increased use of the statins than did generalists (P<.001). It is possible to shift practice if the evidence of benefit is strong, the intervention is easy to implement, and the intervention is marketed aggressively.