Trends in lipid-modifying agent use in 83 countries

Abstract

AimsLipid-modifying agents (LMAs) are increasingly used to reduce lipid levels and prevent cardiovascular events, but the magnitude of their consumption in different world regions is unknown. We aimed to describe recent global trends in LMA consumption and to explore the relationship between country-level LMA consumption and cholesterol concentrations.Methods and resultsThis cross-sectional and ecological study used monthly pharmaceutical sales data from January 2008 to December 2018, for 83 countries from the IQVIA Multinational Integrated Data Analysis System, and total and non–high-density lipoprotein (non– HDL) cholesterol concentrations from the NCD Risk Factor Collaboration. The compound annual growth rate (CAGR) was used to assess changes in LMA consumption over time. From 2008 to 2018, the use of LMAs increased from 7,468 to 11,197 standard units per 1000 inhabitants per year (CAGR 4.13%). Statins were the most used class of LMA and their market share increased in 75% of countries between 2008 and 2018. Fibrates were the most consumed nonstatin drugs. From 2013 to 2018, consumption of low-density lipoprotein lowering therapies increased (statins 3.99%; ezetimibe 4.01%; proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors 104.47%). Limited evidence supports a clear relationship between country-level changes in LMA consumption and total and non–HDL cholesterol concentrations in 2008 versus 2018.ConclusionSince 2008, global access to LMAs, especially statins, has improved. In line with international lipid guideline recommendations, recent trends indicate growth in the use of statins, ezetimibe, and PCSK9 inhibitors. Country-level patterns of LMA use and total and non–HDL cholesterol varied considerably.

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“…Statins are one of the mainstays of treatment and widely used for lowering cholesterol (Gotto and Moon, 2012). Statins have demonstrated benefits in preventing coronary artery disease and reducing cardiovascular risk in patients with type 2 diabetes mellitus (DM) and hypertension, thus benefiting the majority of high-risk individuals (Endo, 1988;Blais et al, 2021;Collins et al, 2003;Adhyaru and Jacobson, 2018;O'Malley et al, 2020;Krane et al, 2016;Pedersen et al, 2004;Watanabe et al, 2006;Goldstein and Brown, 1990;Cholesterol Treatment Trialists' Collaboration and Cholesterol Treatment Trialists' Collaboration, 2024). For DM patients, elevated cholesterol level is one of the risk factors for diabetic nephropathy, so it is also very important for DM patients to strictly control the blood lipid level (Chen and Tseng, 2013;Collins et al, 2016;Cai et al, 2021;DeFronzo et al, 2021;Kelsey et al, 2022;Zhou et al, 2023).…”

“…Statins (hydroxymethylglutaryl-Coenzyme A reductase inhibitors) are the most prescribed drugs in clinical practice, which was effective in lowering LDL cholesterol (Blais et al, 2021;Zhou et al, 2023). As has long been recognized, patients diagnosed with type 2 diabetes are more likely to develop hyperlipidemia (McGarry, 2002;Huang et al, 2023).…”

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“…Statins are the most common lipid-lowering drugs, with an estimated 145.8 million users in 2018 (Blais et al, 2021). During recent decades, multiple studies on the anti-cancer effects of statins have been conducted, most of which indicate that statins reduce progression and prolong survival (Matusewicz et al, 2015;Wang et al, 2016;Mei et al, 2017;Chimento et al, 2018;Iarrobino et al, 2018).…”