Evolution of statin prescribing 1994-2001: a case of agism but not of sexism?

Abstract

Objective: To study trends in the use of lipid lowering drugs in the UK, and to assess which patient factors influence prescribing. Methods: Routinely collected computerised medical data were analysed from 142 general practices across England and Wales that provide data for the Doctors' Independent Network database. Subjects included were people aged 35 years or more with treated ischaemic heart disease, averaging annually over 30 000. The temporal trend from 1994 to 2001 in prescription of lipid lowering drugs and daily statin dose and the odds ratios (ORs) for receiving a statin prescription in 1998 were examined. Results: Lipid lowering drug prescribing increased greatly over time, entirely because of statins, so that in 2001 56.3% of men and 41.1% of women with ischaemic heart disease received lipid lowering drugs. However, 33% of these patients were on a < 20 mg simvastatin daily equivalent. In 1998 the OR for receiving a statin fell from 1 at age 55-64 to 0.64 at 65-74 and 0.16 at 75-84 years. The age effect was similar in those without major comorbidity. Revascularised patients were much more likely to receive a statin than those with angina (OR 3.92, 95% confidence interval (CI) 3.57 to 4.31). Men were more likely to receive a statin than women (OR 1.62, 95% CI 1.54 to 1.71) but this difference disappeared after adjustment for age and severity of disease (OR 1.06). Geographical region had little effect but there was a very weak socioeconomic gradient. Conclusions: Although prescribing has increased, many patients who may benefit from lipid lowering drugs either do not receive it or are undertreated, possibly because of lack of awareness of the relative potency of the different statins. Patients with angina and the elderly are less likely to receive treatment that may prevent a coronary event.

Initiation of Statins After Hospitalization for Coronary Heart Disease

“…As expected and consistent with previous studies, 13,15,28 patients with dyslipidemia before CHD hospitalization and those hospitalized because of AMI were more likely to start statin therapy after discharge. Although the presence of baseline diabetes and hypertension was significantly associated with a lower likelihood of initiation of statins in univariate analysis, the significance disappeared after controlling for other factors, indicating that they were not independent factors and the lower observed rate of statin use in patients with diabetes and hypertension might be confounded by other factors.…”

“…41,42 Regarding gender, previous studies have suggested that men are more likely to receive a statin than women, but the difference disappears once age differences and other factors are controlled. 15,41 In contrast, our findings show a gender bias regarding initiation of statin therapy after discharge from CHD hospitalization after adjustment for other factors. The discrepancy with previous literature might be because of the difference in study populations.…”

“…14 In previous studies, relevant factors associated with lipid-modifying drugs included diagnostic testing for lipids, younger age, history of MI or coronary artery bypass grafting, hypertension, and treatment by cardiology specialists. 13,15 Although an informative body of research has examined the use of lipid-modifying drugs and has explored factors that might affect their use, few studies have focused on patients discharged from a CHD hospitalization or examined financial concerns such as patients' medication copayment requirements. Therefore, the primary objectives of this study were to estimate the proportion of patients who receive statin therapy after being discharged from CHD hospitalization and to identify the factors that affect the initiation of statin therapy among these patients.…”

“…[10][11][12][13][14][15] For instance, one observational study using 2001 medical and drug claims data from a managed care organization revealed that only 15,984 of 40,179 (39.8%) of CHD patients were receiving statin therapy (including "risk equivalent" CHD patients, such as persons with diabetes, aortic aneurysm, and peripheral arterial disease). 14 In previous studies, relevant factors associated with lipid-modifying drugs included diagnostic testing for lipids, younger age, history of MI or coronary artery bypass grafting, hypertension, and treatment by cardiology specialists.…”

Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD: A video-simulation experiment

“…Ecological analyses of hospital procedures have shown lower rates of angiography and revascularisation in practices with high deprivation scores (Hippsley-Cox & Pringle, 2000). Practice-based data show that men with heart disease are more likely to receive lipid-lowering drugs than women, with a greater gender bias among the 45-54 than older age groups (Hippisley-Cox, Pringle, Crown, Meal & Wynn, 2001), while DeWilde, Carey, Bremner, Richards, Hilton & Cook (2003) found lower prescription of lipid lowering drugs with increased age, but no sex difference after adjustment for disease severity. A population-based survey in Boston of patients seeking care for heart symptoms found lower cardiologist referral rates among blacks, and white women received less CHD-related treatment than men (Crawford, McGraw, Smith, McKinlay & Pierson, 1994;McKinlay, 1996).…”