Trends in statin therapy initiation during the period 2000-2010 in Israel

Systematic review and meta-analysis of studies assessing the relationship between statin use and risk of ovarian cancer

PURPOSE

The link between lipid-stabilizing medications and epithelial ovarian carcinogenesis is incompletely understood. Statins may reduce ovarian cancer risk, but results are inconclusive.

METHODS

We conducted a systematic review and meta-analysis of studies reporting associations between statin use and ovarian cancer risk in PubMed. Summary risk ratios (RRs) and confidence intervals (CIs) were calculated. Subgroup analyses by cancer histotype, statin class (lipo- or hydrophilic) and duration of statin use were conducted. Use of individual statins in populations was assessed to determine population-specific differences in statin types.

RESULTS

Nine studies with 435,237 total women were included (1 randomized controlled trial (RCT); 4 prospective; 4 case-control). Statin use was associated with a reduced risk of ovarian cancer (RR 0.87, 95% CI 0.74-1.03) and risk was significantly reduced in populations with low pravastatin use (RR 0.83, 95% CI 0.70-0.99). Risk estimates varied by statin class (3 studies; lipophilic: RR 0.88, 95% CI 0.69-1.12; hydrophilic: RR 1.06, 95% CI 0.72-1.57) and cancer histotype (3 studies; serous: RR 0.95, 95% CI 0.69-1.30; clear cell: RR 1.17, 95% CI 0.74-1.86). Long-term use was associated with a reduced risk of ovarian cancer (RR 0.77, 95% CI 0.54-1.10) that further reduced when pravastatin use was low (RR 0.68, 95% CI 0.46-1.01). Between-study heterogeneity was high overall and in subgroups (I² > 60%).

CONCLUSION

Statins may be associated with a reduced risk of ovarian cancer, but the effect likely differs by individual statin, duration of use and cancer histotype. Additional well-powered studies are needed to elucidate important subgroup effects.

Time trends in statin use and incidence of recurrent cardiovascular events in secondary prevention between 1999 and 2013: a registry-based study

Background

The current study evaluated time trends of statin use and incidence of recurrent CVD in secondary prevention from 1999 to 2013 and investigated which factors were associated with statin use in secondary prevention.

Methods

Intego is a primary care registration network with 111 general practitioners working in 48 practices in Flanders, Belgium. This retrospective registry-based study included patients aged 50 years or older with a history of CVD. The time trends of statin use and incidence of recurrent CVD in secondary prevention were determined by using a joinpoint regression analysis. Multivariable mixed-effect logistic regression analysis was used to assess factors associated with statin use in patients in secondary prevention in 2013.

Results

The overall prevalence of statin use increased and showed two trends: a sharp increase from 1999 to 2005 (annual percentage change (APC) 25.4%) and a weaker increase from 2005 to 2013 (APC 3.7%). The average increase in statin use was the highest in patients aged 80 and older. Patients aged 70–79 years received the most statins. Men used more statins than women did, but both genders showed similar time trends. The incidence of CVD decreased by an average APC of 3.9%. There were no differences between men and women and between different age groups. A significant decrease was only observed in older patients without statins prescribed. In 2013, 61% of the patients in secondary prevention did not receive a statin. The absence of other secondary preventive medication was strongly associated with less statin use. Gender, age and comorbidity were associated with statin use to a lesser degree.

Conclusions

The prevalence of statin use in secondary prevention increased strongly from 1999 to 2013. Less than 50% of patients with a history of CVD received a statin in 2013. Especially patients who did not receive other secondary preventive medication were more likely to not receive a statin. Despite the strong increase in statin use, there was only a small decrease in the incidence of recurrent CVD, and this occurred mainly in older patients without statins prescribed.

The Potential Effects of Implementing the 2013 ACC/AHA Cholesterol Guidelines on the Use of Statins in a Large Health Maintenance Organization in Israel

BACKGROUND

The 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines for the management of blood cholesterol identify candidates for statin therapy to prevent atherosclerotic cardiovascular disease (ASCVD).

OBJECTIVE

The objective was to estimate the effect of adopting the ACC/AHA guidelines in Maccabi Healthcare Services (MHS), a large health maintenance organization in Israel.

METHODS

This population-based study, conducted in June 2014, included all MHS members 40 years or older. We searched the computerized database of MHS to determine the number of members currently on statins, calculated the number of additional members newly eligible for statin treatment according to the new guidelines, and estimated the cost of implementing the guidelines in MHS.

RESULTS

In June 2014, there were 798,076 MHS members 40 years or older. Of the 725,784 members included, 30% were receiving statin treatment at baseline. Adopting the new guidelines would increase the proportion of statin-treated members to 48% (58% and 39% among men and women, respectively). Newly eligible members were more likely to be 55 to 69 years old, men, and have a predicted 10-year ASCVD risk of 7.5% or more. The calculated incremental annual cost for medications is 54 million new Israeli shekels (US $13.5 million). The cost per cardiovascular event prevented is estimated at 82,000 new Israeli shekels (US $20,500).

CONCLUSIONS

Adopting the ACC/AHA 2013 cholesterol guidelines would increase the number of MHS members 40 years or older eligible for statin therapy by 60%, with the increase mainly in primary prevention due to the predicted 10-year ASCVD risk.