Population-wide cohort study of statin use for the secondary cardiovascular disease prevention in Scotland in 2009-2017.

Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 9602087 Publication Model: Electronic Cited Medium: Internet ISSN: 1468-201X (Electronic) Linking ISSN: 13556037 NLM ISO Abbreviation: Heart Subsets: MEDLINE

Original Publication: London : BMJ Pub. Group, c1996-

Hydroxymethylglutaryl-CoA Reductase Inhibitors*/therapeutic use ; Cardiovascular Diseases*/epidemiology ; Cardiovascular Diseases*/prevention & control ; Brain Ischemia* ; Stroke* ; Atherosclerosis*/epidemiology ; Myocardial Infarction* ; Peripheral Arterial Disease*/drug therapy ; Peripheral Arterial Disease*/epidemiology ; Peripheral Arterial Disease*/prevention & control ; Ischemic Stroke*; Male ; Adult ; Humans ; Female ; Middle Aged ; Secondary Prevention ; Cohort Studies ; Retrospective Studies ; State Medicine ; Scotland/epidemiology

Objective: To estimate the extent of suboptimal statin use for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD) at different stages of the treatment pathway and identify patient groups at risk of suboptimal treatment.
Methods: National retrospective cohort study using linked National Health Service Scotland administrative data of adults hospitalised for an ASCVD event (n=167 978) from 2009 to 2017. Proportions of patients initiating, adhering to, discontinuing and reinitiating statins were calculated. We separately examined treatment following myocardial infarction (MI), ischaemic stroke and peripheral arterial disease (PAD) hospitalisations. Multivariable logistic regression and Cox proportional hazards models were used to assess the roles of patient characteristics in the likelihood of initiating and discontinuing statins.
Results: Of patients hospitalised with ASCVD, only 81% initiated statin therapy, 40% of whom used high-intensity statin. Characteristics associated with lower odds of initiation included female sex (28% less likely than men), age below 50 years or above 70 years (<50 year-olds 26% less likely, and 70-79, 80-89 and ≥90 year-olds 22%, 49% and 77% less likely, respectively, than 60-69 year-olds), living in the most deprived areas and history of mental health-related hospital admission. Following MI, 88% of patients initiated therapy compared with 81% following ischaemic stroke and 75% following PAD events. Of statin-treated individuals, 24% discontinued treatment. Characteristics associated with discontinuation were similar to those related to non-initiation.
Conclusions: Statin use remains suboptimal for the secondary ASCVD prevention, particularly in women and older patients, and following ischaemic stroke and PAD hospitalisations. Improving this would offer substantial benefits to population health at low cost.
Competing Interests: Competing interests: The Nuffield Department of Population Health has a policy that staff members do not receive personal payments, directly or indirectly, from industry. DP reports that he is a committee member for the ongoing National Institute for Health and Care Excellence Cardiovascular Disease: Risk Assessment and Reduction, including Lipid Modification guideline, and an investigator on the ORION-4 trial (inclisiran vs placebo for the secondary prevention of CVD), which is funded by a grant from Novartis to the University of Oxford but for which he obtains no salary support. DP and BM report that they are members of the Cholesterol Treatment Trialists’ Collaboration Secretariat. BM, AG and IS are investigators in the ongoing NIHR HTA project 17/140/02 'Cost-effectiveness of statin therapies evaluated using individual participant data from large randomised clinical trials'.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

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RE/13/1/30181 United Kingdom BHF_ British Heart Foundation; United Kingdom MRC_ Medical Research Council

Keywords: Coronary Artery Disease; Medication Adherence; Quality of Health Care; STATINS; Stroke

0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)

Date Created: 20221003 Date Completed: 20230216 Latest Revision: 20230309

20240628

PMC9985707

10.1136/heartjnl-2022-321452

36192149