The influence of guidelines on the use of statins: analysis of prescribing trends 1998–2002

Abstract

Aims:To monitor statin prescribing trends over time in order to determine whether prescribers were influenced by study results and/or clinical guidelines in terms of type and dosage of statin prescribed. MethodsThe GMS (General Medical Services) prescription database in Ireland was used to identify a cohort of patients, prescribed statins, in order to investigate prescribing trends from January 1998-December 2002. Statin prescribing rates for patients with ischaemic heart disease and diabetes were compared with rates in the general GM S population. Logistic regression analysis was used in patients with ischaemic heart disease and diabetes and adjusted odds ratios and 95% confidence intervals presented. ResultsIncreased statin prescribing over time was noted (test for linear trend P < 0.0001). Pravastatin was the most frequently prescribed, followed by atorvastatin; simvastatin and fluvastatin showed lower rates of prescribing. Atorvastatin showed the g reatest increased rate over time. An increase in the overall dose prescribed (test for trend P < 0.01) was chiefly due to increases in pravastatin dose, but doses were still below those recommended from clinical trials. Statins were prescribed more frequently in patients with ischaemic heart disease and diabetes, 44% (95% CI 43-45%) compared with the total GMS population, 7.7% (95% CI 7.6-7.8%), by December 2002. However, statins were only prescribed to 52% (95% CI 51-53%) of ischaemic heart disease patients and 40% (95% CI 39-41%) of patients with diabetes by December 2002. Patients aged 45-64 years were more likely to receive statins, compared with those aged 65 years and older. Conclusion:These findings suggest that the beneficial effects of statins shown in clinical studies may not be achieved in practice.

Statin utilization according to indication and age: A Danish cohort study on changing prescribing and purchasing behaviour

“…While a range of studies have explored the increasing statin utilization according to gender and age [2,4,[22][23][24][25], others have demonstrated that guideline implementation tend to increase in drug utilization [4,5,26]. However, it has been questioned whether statins are prescribed to those who benefit most i.e.…”

“…During the last two decades, the utilization of statins (HMG-CoA reductase inhibitors) has increased considerably in most western countries [1][2][3][4][5], causing debates on the appropriateness of the prescribing pattern [6,7]. The beneficial effect of statins in patients with myocardial infarction (MI) and hypercholesterolemia was demonstrated in 1994, showing considerably reduced post-MI mortality in middle-aged men [8].…”

Simvastatin: between clinics and health economics

“…Il vero problema da risolvere è costituito dal fatto che le linee guida vengono seguite solo in parte dai medici e i pazienti trattati, anche se sono aumentati nel tempo, sono meno di quelli che dovrebbero essere; oltre a ciò, le terapie sono troppo discontinue e spesso si utilizzano dosi inadeguate [35][36][37].…”

“…Francesco Vittorio Costa (1) , Orietta Zaniolo (2) Farmeconomia e percorsi terapeutici 2007; 8 (1): [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] dal fungo Penicillum Citrinum, il primo inibitore dell'HMG-CoA reduttasi (compactina ML-236B). Infine, nel 1979, Hoffman e colleghi, nei laboratori della MS&D, isolarono da un ceppo del fungo Aspergillus Terreus, la prima statina d'impiego clinico: lovastatina.…”

Drug-drug Interactions of Statins Potentially Leading to Muscle-Related Side Effects in Hospitalized Patients

“…Following their increased utilization, controversies arose on their prescription patterns due to safety concerns [1][2][3][4][5][6][7]. Common adverse effects of statins include dyspepsia, flatulence, constipation, generalized gastrointestinal discomfort, elevated transaminase levels, myalgia, headache, sleep disorders and central nervous system disturbances [8].…”