Trends in coronary heart disease mortality and statin utilization in two European areas with different population risk levels: Stockholm and Sicily

Abstract

Background and Aim: The reduction in coronary heart disease (CHD) mortality in Europe has been associated with a<br />reduction in coronary risk factors, including dyslipidaemia. Statins reduce blood cholesterol levels and the risk of coronary<br />events. Their utilization has substantially increased over the years. Although statins should be prescribed according to clinical<br />guidelines, doctors’ decisions about treatment are usually made subjectively and are influenced by the population risk level.<br />The aim of this study was to investigate the relation between the time trend of population risk level and statin utilization in two<br />areas with different levels of coronary risk in the population.<br />Methods: CHD mortality, as a proxy of population coronary risk level, and statin utilization trends in the period 2001-2011,<br />were compared between a relatively high-risk CHD area, Stockholm county, and a low-risk area, Sicily.<br />Results: There was a reduction in CHD mortality and an increase in statin utilization in both areas. The mean annual reduction<br />in CHD mortality rate/100,000 was greater in Stockholm than in Sicily (-4.6, 95% CI -5.3 -4.0, and -1.9 95% CI -2.6 – 1.2,<br />respectively). The mean annual increase in statin DDD/TID utilization was larger in Sicily than in Stockholm (5.1, 95% CI 4.8 –<br />5.3, and 3.7, 95% CI 3.2 – 4.1, respectively). In Stockholm the increase in statin use was mainly due to increased utilization of<br />simvastatin, whereas it included a greater variety of statins in Sicily.<br />Conclusion: The relations between time trends of CHD mortality and statin utilization in Stockholm and in Sicily were<br />different. A larger increase in statins was observed in the low-risk area, associated with a slower reduction in CHD mortality,<br />whereas a smaller increase in statins was observed in the high-risk area, associated with a greater reduction in CHD mortality.<br />Other factors apart from the actual risk of the patients may explain these observations, such as differences in socioeconomic<br />factors, adherence to treatment, policies of drug cost-containment, and population CHD risk profiles.

Time trends in statin utilisation and coronary mortality in Western European countries

“…We recently observed that statin utilisation is higher in Stockholm, Sweden, which is a relatively high-risk area, compared to Sicily, Italy, with a lower population risk level. 32 However, the analysis of the time trend of changes in statin utilisation and CHD mortality rates in these regions between 2000 and 2011 showed that statin utilisation increased more rapidly in Sicily, where the reduction in CHD mortality was slower, whereas a smaller increase occurred in Stockholm, with a larger reduction in CHD mortality. Such discordance between time trends may indicate that the doctors' attitude to initiating statin treatment is influenced by factors not directly related to the actual patient risk, such as the doctors' gender and length of clinical experience, patients' attitudes to medicines, drug reimbursement policies, prescribing restrictions and marketing by pharmaceutical companies.…”

Intensive Lipid Lowering Therapy among patients with Coronary Artery Disease: a Middle Eastern tertiary care center experience

“…5,6,7 Moreover, it varies widely among different populations, possibly due to physician preferences, cultural differences, socioeconomic factors, adherence to treatment, drug cost, and population CHD risk profiles. 8 While the reasons for not prescribing statin were not available to us, the study highlights an important discrepancy between guidelines for optimal lipid lowering therapy and current practice.…”

Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments

“…Although the patterns were broadly similar there were some important differences between countries. For instance Tunisia had a much higher uptake of statins for primary prevention, but in other populations these uptakes remained low at the end of our period of analysis (approximately 2008), suggesting significantly greater potential with increasing use in the future 42 . Simple, accepted drug regimens or combinations (generally including aspirin, a calcium channel blocker, ACE inhibitor and statin) may be cost-effective for CHD patients even in low income settings and merit further study 43 44 .…”