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Wettermark B, Kalantaripour C, Forslund T, Hjemdahl P. Statin treatment for primary and secondary prevention in elderly patients-a cross-sectional study in Stockholm, Sweden. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03724-3. [PMID: 39012537 DOI: 10.1007/s00228-024-03724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Age is a major risk factor for atherosclerotic cardiovascular disease (CVD) and death, but there has been a debate about benefit-risk of statin treatment in the elderly with limited evidence on benefits for primary prevention, while there is strong evidence for its use in secondary prevention. AIM The aim of this study was to provide an overview of statin utilization in primary and secondary prevention for patients 75-84 years and ≥ 85 years in the Swedish capital Region Stockholm in 2019. METHODS This is a cross-sectional study based on the regional healthcare database VAL containing all diagnoses and dispensed prescription drugs for all 174,950 inhabitants ≥ 75 years old in the Stockholm Region. Prevalence and incidence were analyzed by sex, age, cardiovascular risk, substance, and the intensity of treatment. RESULTS A total of 35% of all individuals above the age of 75 in the region were treated with statins in 2019. The overall incidence in this age group was 31 patients per 1000 inhabitants. Men, individuals 75-84 compared to ≥ 85 years of age, and those with higher cardiovascular risk were treated to a greater extent. Simvastatin was used primarily by prevalent users and atorvastatin by incident users. The majority was treated with moderate-intensity dosages and fewer women received high intensity treatment. CONCLUSIONS Statins are widely prescribed in the elderly. Physicians seem to consider individual cardiovascular risk when deciding to initiate statin treatment for elderly patients, but here may still be some undertreatment among high-risk patients (especially women and elderly 85 + years) and some overtreatment among patients with low-risk for CVD.
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Affiliation(s)
- Björn Wettermark
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Box 580, 751 23, Uppsala, Sweden.
| | - Camelia Kalantaripour
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Box 580, 751 23, Uppsala, Sweden
| | - Tomas Forslund
- Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute and Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
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Hoffmann M, Støvring H. Incidence in pharmacoepidemiology: A conceptual framework for incidence of a single substance or group of substances with statins as an example. Basic Clin Pharmacol Toxicol 2023; 132:171-179. [PMID: 36414232 PMCID: PMC10107903 DOI: 10.1111/bcpt.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/03/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022]
Abstract
A framework for analysing incidence in pharmacoepidemiology and drug statistics is suggested using statins as an example. A new case of statin use (first-ever use or recurrence of treatment) can be defined as new on the group (NoG), new on substance whether new on the group or not (NoS), new on substance and new on the group (NoS_and_NoG), new on substance and not new on the group (NoS_not_NoG). METHOD Individual-level dispensations of statins 2006-2019 for 1 017 058 individuals with at least one dispensation 2019 in Sweden. RESULTS With 12-month run-in, corresponding to at least 8 months without treatment, the incidence proportion of NoG was 13.39 new cases per 1000 inhabitants and 8.40 with 10-year run-in. Thus, 37% had first been treated with any statin between 12 months and 10 years before the index date. For atorvastatin, NoS was 10.69, NoS_and_NoG 9.99, and NoS_not_NoG 0.70 per 1000 inhabitants. 0.70 per 1000 inhabitants or 6.6% of new cases of atorvastatin represented a change from another statin during the run-in. CONCLUSION It is essential to separate new cases that are new both on the substance and on the group from those that represent a change of therapy during the run-in.
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Affiliation(s)
- Mikael Hoffmann
- Health Care Analysis, Division of Society and Health, Linköping University, Linköping, Sweden.,The NEPI Foundation, Stockholm, Sweden
| | - Henrik Støvring
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
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Martínez-Moneo E, Cárdenas-Jaén K, Fernández-Laso AB, Millastre-Bocos J, Torralba-Gallego A, Martín-Arriero S, Alfaro-Almajano E, García-Rayado G, de-Madaria E. Statin consumption and risk of post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreatology 2020; 20:801-805. [PMID: 32448748 DOI: 10.1016/j.pan.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/03/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP acute pancreatitis (PEP). Statin consumption seems to lower the incidence of acute pancreatitis. We aimed to investigate the relationship between the use of statins and the incidence of PEP. METHODS multicenter (4 Spanish tertiary-level public hospitals) retrospective cohort study. Adult patients undergoing an ERCP were included in the study. We excluded patients with chronic pancreatitis, with ongoing acute pancreatitis and those who developed other complications after ERCP. Patients were classified into 2 groups: those under statin treatment (group S) and controls (group C). A multivariate analysis was performed (binary logistic regression) including age, center, female gender, previous pancreatitis, suspected sphincter of Oddi dysfunction, difficult cannulation (>10 min), >1 pancreatic guidewire passages, pancreatic injection, pancreatic stenting and presence of choledocholitiasis. RESULTS seven hundred and two patients were included, median age 74 (62-82 years), 330 (47%) females, 223 (32%) in group S. Thirty-five (5%) patients developed PEP, 6 (3%) in group S and 29 (6%) in group C. Statin use was not associated with a lower frequency of PEP in univariate analysis, OR 0.429 (95% confidence interval 0.176-1.05, p = 0.06) or in multivariate analysis, adjusted OR 0.5 (0.19-1.32), p = 0.16. Statin use had no effect on severity of PEP, being mild in 50% vs 78.6% in non-statin users, p = 0.306. CONCLUSIONS the chronic use of statins was not associated with a decreased risk of PEP or a milder course of disease in our sample of patients.
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Affiliation(s)
- Emma Martínez-Moneo
- Gastroenterology Department, Cruces University Hospital, Barakaldo, Vizcaya, Spain
| | - Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Judith Millastre-Bocos
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute (ISS Aragon), Zaragoza, Spain
| | | | | | - Enrique Alfaro-Almajano
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute (ISS Aragon), Zaragoza, Spain
| | - Guillermo García-Rayado
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute (ISS Aragon), Zaragoza, Spain
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
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O’Grady M, Clarke L, Turner G, Doogue M, Purcell R, Pearson J, Frizelle F. Statin use and risk of acute diverticulitis: A population-based case-control study. Medicine (Baltimore) 2020; 99:e20264. [PMID: 32443369 PMCID: PMC7253659 DOI: 10.1097/md.0000000000020264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The goal of the study was to examine the association between statin use and the development of acute diverticulitis requiring hospital admission.Acute diverticulitis is a common and costly gastrointestinal disorder. Although the incidence is increasing its pathophysiology and modifiable risk factors are incompletely understood. Statins affect the inflammatory response and represent a potential risk reducing agent.A retrospective, population-based, case-control study was carried out on a cohort of adults, resident in Canterbury, New Zealand. All identified cases were admitted to hospital and had computed tomography confirmed diverticulitis. The positive control group comprised patients on non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), and the negative control group were patients on selective serotonin reuptake inhibitors (SSRIs). Medicine exposure was obtained from the Pharmaceutical Management Agency of New Zealand. Subgroup analysis was done by age and for complicated and recurrent diverticulitis.During the study period, there were 381,792 adults resident in Canterbury. The annual incidence of diverticulitis requiring hospital presentation was 18.6 per 100,000 per year. Complicated disease was seen in 37.4% (158) of patients, and 14.7% (62) had recurrent disease. Statins were not found to affect the risk of developing acute diverticulitis, nor the risk of complicated or recurrent diverticulitis. Subgroup analysis suggested statin use was associated with a decreased risk of acute diverticulitis in the elderly (age >64 years). NSAIDs were associated with a decreased risk of acute diverticulitis (risk ratio = 0.65, confidence interval: 0.26-0.46, P < .01), as were SSRIs (risk ratio = 0.37, confidence interval: 0.26-0.54, P < .01).This population-based study does not support the hypothesis that statins have a preventative effect on the development of diverticulitis, including complicated disease. We also found a decreased risk of diverticulitis associated with NSAID and SSRI use.
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Affiliation(s)
| | | | | | - Matt Doogue
- University of Otago, Christchurch, New Zealand
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Eilat-Tsanani S, Mor E, Schonmann Y. Statin Use Over 65 Years of Age and All-Cause Mortality: A 10-Year Follow-Up of 19 518 People. J Am Geriatr Soc 2019; 67:2038-2044. [PMID: 31287932 DOI: 10.1111/jgs.16060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long-term effects of adherence to statins on mortality and cardiovascular morbidity among older adults. DESIGN A historical population-based cohort study using routinely collected data. SETTING Clalit Health Services Northern District. PARTICIPANTS We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years. MEASUREMENTS We fitted Cox regression models to assess the association between the adherence to statin therapy and all-cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time-updated variables. RESULTS The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All-cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] = .66; 95% confidence interval [CI] = .56-.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR = .80; 95% CI = .71-.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men. CONCLUSION Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex. J Am Geriatr Soc 67:2038-2044, 2019.
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Affiliation(s)
- Sophia Eilat-Tsanani
- Department of Family Medicine, Clalit Health Services Northern District, Israel.,Department of Family Medicine, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Elad Mor
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Yochai Schonmann
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Family Medicine, Clalit Health Services, Rabin Medical Center, Petah Tikva, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Byrne P, Cullinan J, Smith A, Smith SM. Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews. BMJ Open 2019; 9:e023085. [PMID: 31015265 PMCID: PMC6500096 DOI: 10.1136/bmjopen-2018-023085] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To synthesise evidence from exclusively primary prevention data on the effectiveness of statins for prevention of cardiovascular disease (CVD), including stroke, and outcomes stratified by baseline risk and gender. DESIGN Overview of systematic reviews (SRs) using Revised-AMSTAR approach to assess quality. DATA SOURCES Cochrane Database of Systematic Reviews, MEDLINE, Embase, PubMed, Scopus and PROSPERO to June 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES SRs of randomised control trials (RCTs) or individual patient data (IPD) from RCTs, examining the effectiveness of statins versus placebo or no treatment on all-cause mortality, coronary heart disease, CVD (including stroke) and composite endpoints, with stratification by baseline risk and gender. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed methodological quality. A narrative synthesis was conducted. RESULTS Three SRs were included. Quality of included SRs was mixed, and none reported on the risk of bias of included trials.We found trends towards reduced all-cause mortality in all SRs (RR 0.91 [95% CI 0.85 to 0.97]), (RR 0.91 [95% CI 0.83 to 1.01]) and (RR 0.78 [95% CI 0.53 to 1.15]) though it was not statistically significant in two SRs. When stratified by baseline risk, the effect on all-cause mortality was no longer statistically significant except in one medium risk category. One review reported significant reductions (RR 0.85 [95% CI 0.77 to 0.95]) in vascular deaths and non-significant reductions in non-vascular deaths (RR 0.97 [95% CI 0.88 to 1.07]). There were significant reductions in composite outcomes overall, but mixed results were reported in these when stratified by baseline risk. These reviews included studies with participants considered risk equivalent to those with established CVD. CONCLUSIONS There is limited evidence on the effectiveness of statins for primary prevention with mixed findings from studies including participants with widely ranging baseline risks. Decision making for the use of statins should consider individual baseline risk, absolute risk reduction and whether risk reduction justifies potential harms and taking a daily medicine for life. TRIAL REGISTRATION NUMBER CRD42017064761.
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Affiliation(s)
- Paula Byrne
- J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Amelia Smith
- Department of Pharmacology and Therapeutics, University of Dublin Trinity College, Dublin, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Riis AH, Erichsen R, Ostenfeld EB, Højskov CS, Thorlacius‐Ussing O, Stender MT, Lash TL, Møller HJ. Validating registry data on statins prescriptions by blood measurements. Pharmacoepidemiol Drug Saf 2019; 28:609-615. [DOI: 10.1002/pds.4700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/07/2018] [Accepted: 10/17/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Anders H. Riis
- Department of Clinical EpidemiologyAarhus University Hospital Aarhus Denmark
| | - Rune Erichsen
- Department of Clinical EpidemiologyAarhus University Hospital Aarhus Denmark
| | - Eva B. Ostenfeld
- Department of Clinical EpidemiologyAarhus University Hospital Aarhus Denmark
| | - Carsten S. Højskov
- Department of Clinical BiochemistryAarhus University Hospital Aarhus Denmark
| | - Ole Thorlacius‐Ussing
- Department of Gastrointestinal SurgeryAalborg University Hospital Aalborg Denmark
- Institute of Clinical MedicineAalborg University Aalborg Denmark
- The Danish Colorectal Cancer Group Denmark
| | - Mogens Tornby Stender
- Department of Gastrointestinal SurgeryAalborg University Hospital Aalborg Denmark
- Institute of Clinical MedicineAalborg University Aalborg Denmark
| | - Timothy L. Lash
- Department of Clinical EpidemiologyAarhus University Hospital Aarhus Denmark
- Department of Epidemiology, Rollins School of Public HealthEmory University Atlanta Georgia USA
- Winship Cancer InstituteEmory University Atlanta Georgia USA
| | - Holger Jon Møller
- Department of Clinical BiochemistryAarhus University Hospital Aarhus Denmark
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Blais JE, Chan EW, Law SW, Mok MT, Huang D, Wong IC, Siu CW. Trends in statin prescription prevalence, initiation, and dosing: Hong Kong, 2004–2015. Atherosclerosis 2019; 280:174-182. [DOI: 10.1016/j.atherosclerosis.2018.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 02/08/2023]
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Kinsey TL, Stürmer T, Poole C, Rothman KJ, Glynn RJ. Changing predictors of statin initiation in US women over two decades. Pharmacoepidemiol Drug Saf 2018; 28:305-314. [PMID: 30565779 DOI: 10.1002/pds.4704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/25/2018] [Accepted: 11/02/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe changing roles of predictors of statin initiation before and after incident coronary heart disease, and before and after publication of National Cholesterol Education Program Adult Treatment Panel-III (ATP-III) guidelines in a cohort of US women. METHODS We identified 34 382 women enrolled into the Women's Health Study from 1993 to 1995 and followed up until 2012. Proportions of previous nonusers initiating statins were described over time. We used multivariable linear regression models to estimate adjusted initiation proportion differences (IPDs) for initiation overall, separately before and after incident coronary heart disease, and separately for ATP-II and ATP-III time periods. RESULTS Key predictors of initiation overall were self-reported total cholesterol, and previous incident coronary heart disease, cerebrovascular disease, and diabetes. Adjusted IPDs (percentage) for total cholesterol > 240 vs <200 mg/dL were 7.5 (95% confidence interval [CI], 7.0-8.0) and 9.3 (95% CI, 8.7-9.9) during ATP-II and ATP-III time periods, respectively. Adjusted IPDs in women with diabetes were 7.0 (95% CI, 6.3-7.8) and 11.9 (95% CI, 6.7-17.0) for primary and secondary prevention, respectively, and 3.1 (95% CI, 2.1-4.0) and 9.2 (95% CI 8.2-10.2) for before and after ATP-III, respectively. CONCLUSIONS Secular trends reflected evolution toward risk factor-based treatment indications for statin initiation with increased initiation among diabetics and women with normal and borderline cholesterol. The role of serum cholesterol changed over time, though the character was scale (multiplicative vs additive) dependent. In pharmacoepidemiologic studies of statins, strength of confounding by important variables sometimes unmeasured in claims data, such as cholesterol level, may be calendar time dependent.
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Affiliation(s)
- Tracy L Kinsey
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Robert J Glynn
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Laleman N, Henrard S, van den Akker M, Goderis G, Buntinx F, Van Pottelbergh G, Vaes B. Time trends in statin use and incidence of recurrent cardiovascular events in secondary prevention between 1999 and 2013: a registry-based study. BMC Cardiovasc Disord 2018; 18:209. [PMID: 30400778 PMCID: PMC6220501 DOI: 10.1186/s12872-018-0941-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/16/2018] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Nele Laleman
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium
| | - Séverine Henrard
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium.,Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Marjan van den Akker
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Geert Goderis
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium
| | - Frank Buntinx
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium. .,Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium.
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11
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The rise of statins in Denmark: Making the case for a localized approach to the routinization of pharmaceutical prevention of cardiovascular disease. BIOSOCIETIES 2018. [DOI: 10.1057/s41292-018-0126-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Byrne P, Cullinan J, Murphy C, Smith SM. Cross-sectional analysis of the prevalence and predictors of statin utilisation in Ireland with a focus on primary prevention of cardiovascular disease. BMJ Open 2018; 8:e018524. [PMID: 29439070 PMCID: PMC5829660 DOI: 10.1136/bmjopen-2017-018524] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the prevalence of statin utilisation by people aged over 50 years in Ireland and the factors associated with the likelihood of using a statin, focusing particularly on those using statins for primary prevention of cardiovascular disease (CVD). METHODS This is a cross-sectional analysis of cardiovascular risk and sociodemographic factors associated with statin utilisation from wave 1 of The Irish Longitudinal Study on Ageing. A hierarchy of indications for statin utilisation, consisting of eight mutually exclusive levels of CVD-related diagnoses, was created. Participants were assigned one level of indication. The prevalence of statin utilisation was calculated. The likelihood that an individual was using a statin was estimated using a multivariable logistic regression model, controlling for cardiovascular risk and sociodemographic factors. RESULTS In this nationally representative sample (n=5618) of community-dwelling participants aged 50 years and over, 1715 (30.5%) were taking statins. Of these, 65.0% (57.3% of men and 72.7% of women) were doing so for the primary prevention of CVD. Thus, almost two-thirds of those taking statins did so for primary prevention and there was a notable difference between women and men in this regard. We also found that statin utilisation was highest among those with a prior history of CVD and was significantly associated with age (compared with the base category 50-64 years; 65-74 years OR 1.38 (95% CI 1.16 to 1.65); 75+ OR 1.33 (95% CI 1.04 to 1.69)), living with a spouse or partner (compared with the base category living alone; OR 1.35 (95% CI 1.10 to 1.65)), polypharmacy (OR 1.74 (95% CI 1.39 to 2.19)) and frequency of general practitioner visits (compared with the base category 0 visits per year; 1-2 visits OR 2.46 (95% CI 1.80 to 3.35); 3-4 visits OR 3.24 (95% CI 2.34 to 4.47); 5-6 visits OR 2.98 (95% CI 2.08 to 4.26); 7+ visits OR 2.51 (95% CI 1.73 to 3.63)), even after controlling for clinical need. There was no association between using statins and gender, education, income, social class, health insurance status, location or Systematic Coronary Risk Evaluation (SCORE) risk in the multivariable analysis. CONCLUSION Statin utilisation among those with no history of CVD accounted for almost two-thirds of all statin use, in part reflecting the high proportion of the population with no history of CVD, although utilisation rates were highest among those with a history of CVD.
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Affiliation(s)
- Paula Byrne
- National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- National University of Ireland Galway, Galway, Ireland
| | - Catríona Murphy
- Dublin City University, Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Dublin, Ireland
| | - Susan M Smith
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Kriegbaum M, Lau SR. Medication non-adherence and uncertainty: Information-seeking and processing in the Danish LIFESTAT survey. Res Social Adm Pharm 2017; 14:736-741. [PMID: 29203408 DOI: 10.1016/j.sapharm.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Statins are widely prescribed to lower cardiovascular morbidity and mortality. However, statin non-adherence is very high. PURPOSE The aim of this paper was to investigate reasons for stopping statin treatment in the general population and to study how aspects of information-seeking and processing is associated with statin non-adherence. METHODS This study used a population survey on 3050 Danish residents aged 45-65 years. Reasons for statin discontinuation was studied among those who were previous statin users. The association between information seeking and processing and statin discontinuation were analysed using multivariate logistical regression models. RESULTS Experience of side effects and fear of side effects played an important role in the discontinuation of statin treatment. Feelings of uncertainty and confusion regarding information on statins predicted statin discontinuation. This applied to information from both mass media and from general practitioners. There was no clear pattern of information seeking and statin non-adherence. CONCLUSIONS The article point to the impact of information-seeking on the decision to take cholesterol-lowering medication. This included contributions from information disseminated by media outlets. Side effects and fear of side effects should be addressed in clinical practice. Health care professionals should pay attention to emotional aspects of how information is disseminated and perceived by statin users.
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Affiliation(s)
- Margit Kriegbaum
- Department of Public Health, University of Copenhagen, Denmark, Copenhagen, Denmark.
| | - Sofie Rosenlund Lau
- Department of Anthropology, University of Copenhagen, Denmark, Copenhagen, Denmark
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Kriegbaum M, Liisberg KB, Wallach-Kildemoes H. Pattern of statin use changes following media coverage of its side effects. Patient Prefer Adherence 2017; 11:1151-1157. [PMID: 28744105 PMCID: PMC5513880 DOI: 10.2147/ppa.s133168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The media plays a role in shaping opinions about medical decisions, for example, whether to initiate or stop treatment. An association between negative media attention and statin discontinuation has been demonstrated, but it may differ depending on the reason for prescription and whether the user is new (incident) or long term (prevalent). AIM The aim of this study is to explore whether a Danish newspaper article featuring the side effects of statins affects statin discontinuation in incident versus prevalent users, with the reason for prescription also taken into account. METHODS The study relies on a quasi-experimental design and uses registry data on statin purchases to explore discontinuation and treatment duration. As a proxy for reason for prescription, data on filled prescriptions and hospital diagnoses from a Danish registry were used. We compared statin discontinuation in all statin users in Denmark in 2007 before the media event (n=343,438) and after it in 2008 (n=404,052). RESULTS Compared to 2007, statin discontinuation among prevalent users in 2008 increased by 2.97 percentage points (pp). The change in discontinuation varied with the indication for statin use. Those with myocardial infarction had the smallest increase (1.98 pp) and those with hypercholesterolemia or primary hypertension had the largest increase (3.54 pp). Incident statin users had a higher level of discontinuation and a larger difference in discontinuation between 2007 and 2008. Compared to 2007, more people (5.52 pp) discontinued statin treatment in 2008. Again, those with myocardial infarction had the smallest decrease in statin discontinuation (1.49 pp), while those with a potential atherosclerotic condition (7.05 pp) and hypercholesterolemia or primary hypertension (6.10 pp) had the largest increase. CONCLUSION Statin discontinuation increased in 2008 following a media event, but especially among individuals prescribed statins for primary prevention and among new statin users.
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Affiliation(s)
- Margit Kriegbaum
- Department of Public Health
- Correspondence: Margit Kriegbaum, Department of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen, Denmark, Tel +45 35 33 73 26, Fax +45 35 32 76 29, Email
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Minard LV, Corkum A, Sketris I, Fisher J, Zhang Y, Saleh A. Trends in Statin Use in Seniors 1999 to 2013: Time Series Analysis. PLoS One 2016; 11:e0158608. [PMID: 27434392 PMCID: PMC4951112 DOI: 10.1371/journal.pone.0158608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/17/2016] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To examine HMG-CoA reductase inhibitor (statin) drug dispensing patterns to Nova Scotia Seniors' Pharmacare program (NSSPP) beneficiaries over a 14-year period in response to: 1) rosuvastatin market entry in 2003, 2) JUPITER trial publication in 2008, and 3) generic atorvastatin availability in 2010. METHODS All NSSPP beneficiaries who redeemed at least one prescription for a statin from April 1, 1999 to March 31, 2013 were included. Aggregated, anonymous monthly prescription counts were extracted by the Nova Scotia Department of Health and Wellness (Nova Scotia, Canada) and changes in dispensing patterns of statins were measured. Data were analyzed using descriptive analyses and interrupted time series methods. RESULTS The percentage of NSSPP beneficiaries dispensed any statin increased from 5.3% in April 1999 to 20.7% in March 2013. In 1999, most NSSPP beneficiaries were dispensed either simvastatin (29.5%) or atorvastatin (28.7%). When rosuvastatin was added to the NSSPP Formulary in August 2003, prescriptions dispensed for simvastatin, lovastatin, pravastatin, and fluvastatin declined significantly (slope change, -0.0027; 95% confidence interval (CI), (-0.0046, -0.0009)). This significant decline continued following the publication of JUPITER (level change, -0.1974; 95% CI, (-0.2991, -0.0957)) and the availability of generic atorvastatin (level change, -0.2436; 95% CI, (-0.3314, -0.1558)). Atorvastatin was not significantly affected by any of the three interventions, although it maintained an overall decreasing trend. Only upon the availability of generic atorvastatin did the upward trend in rosuvastatin use decrease significantly (slope change, -0.0010, 95% CI, (-0.0015, -0.0005)). CONCLUSIONS The type and rate of statins dispensed to NSSPP beneficiaries changed from 1999 to 2013 in response to the availability of new agents and publication of the JUPITER trial. The overall proportion of NSSPP beneficiaries dispensed a statin increased approximately 4-fold during the study period. In 2013, rosuvastatin was the most commonly dispensed statin (44.1%) followed by atorvastatin (39.1%).
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Affiliation(s)
- Laura V. Minard
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amber Corkum
- Statistical Consulting Unit, Acadia University, Wolfville, Nova Scotia, Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Fisher
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Ying Zhang
- Statistical Consulting Unit, Acadia University, Wolfville, Nova Scotia, Canada
| | - Ahmed Saleh
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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O'Keeffe AG, Nazareth I, Petersen I. Time trends in the prescription of statins for the primary prevention of cardiovascular disease in the United Kingdom: a cohort study using The Health Improvement Network primary care data. Clin Epidemiol 2016; 8:123-32. [PMID: 27313477 PMCID: PMC4890684 DOI: 10.2147/clep.s104258] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Statins are widely prescribed for the primary prevention of cardiovascular disease. Guidelines exist for statin prescriptions, but there is little recent analysis concerning prescription trends over time and how these vary with respect to demographic variables. Methods and results Using The Health Improvement Network primary care database, statin therapy initiation and statin prescription prevalence rates were calculated using data from 7,027,711 individuals across the UK for the years 1995 to 2013, overall and stratified by sex, age group, and socioeconomic deprivation level (Townsend score). Statin therapy initiation rates rose sharply from 1995 (0.51 per 1,000 person-years) up to 2006 (19.83 per 1,000 person-years) and thereafter declined (10.76 per 1,000 person-years in 2013). Males had higher initiation rates than females and individuals aged 60–85 years had higher initiation rates than younger or more elderly age groups. Initiation rates were slightly higher as social deprivation level increased, after accounting for age and sex. Prescription prevalence increased sharply from 1995 (2.36 per 1,000 person-years) to 2013 (128.03 per 1,000 person-years) with males generally having a higher prevalence rate, over time, than females. Prevalence rates over time were generally higher for older age groups but were similar with respect to social deprivation level. Conclusion The uptake of statins within UK primary care has increased greatly over time with statins being more commonly prescribed to older patients in general and, in recent years, males appear to have been prescribed statins at higher rates than females. After accounting for age and sex, the statin therapy initiation rate increases with the level of social deprivation.
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Affiliation(s)
- Aidan G O'Keeffe
- Department of Statistical Science, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
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Wallach-Kildemoes H, Stovring H, Holme Hansen E, Howse K, Pétursson H. Statin prescribing according to gender, age and indication: what about the benefit-risk balance? J Eval Clin Pract 2016; 22:235-46. [PMID: 26446680 DOI: 10.1111/jep.12462] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 12/12/2022]
Abstract
RATIONALES, AIMS AND OBJECTIVES The increasing dispensing of statins has raised concern about the appropriateness of prescribing to various population groups. We aimed to (1) investigate incident and prevalent statin prescribing according to indication, gender and age and (2) relate prescribing patterns to evidence on beneficial and adverse effects. METHODS A cohort of Danish inhabitants (n = 4 424 818) was followed in nationwide registries for dispensed statin prescriptions and hospital discharge information. We calculated incidence rates (2005-2009), prevalence trends (2000-2010) and absolute numbers of statin users according to register proxies for indication, gender and age. RESULTS In 2010, the prevalence became highest for ages 75-84 and was higher in men than women (37% and 33%, respectively). Indication-specific incidences and prevalences peaked at ages around 65-70, but in myocardial infarction, the prevalence was about 80% at ages 45-80. Particularly, incidences tended to be lower in women until ages of about 60 where after gender differences were negligible. In asymptomatic individuals (hypercholesterolaemia, presumably only indication) aged 50+, dispensing was highest in women. The fraction of statin dispensing for primary prevention decreased with age: higher for incident than prevalent prescribing. Independent of age, this fraction was highest among women, e.g. 60% versus 45% at ages 55-64. The fraction for potential atherosclerotic condition (PAC, e.g. heart failure) increased with age. CONCLUSION Prevalence of statin utilization was highest for ages 75-84, although indication-specific measures were relatively low. Despite inconclusive evidence for a favourable risk-benefit balance, statin prescribing was high among people aged 80+, asymptomatic women and PAC patients.
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Affiliation(s)
- Helle Wallach-Kildemoes
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Stovring
- Biostatistics, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Ebba Holme Hansen
- Section for Social and Clinical Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth Howse
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Hálfdán Pétursson
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Kulenovic I, Mortensen MB, Bertelsen J, May O, Dodt KK, Kanstrup H, Falk E. Statin use prior to first myocardial infarction in contemporary patients: Inefficient and not gender equitable. Prev Med 2016; 83:63-9. [PMID: 26687101 DOI: 10.1016/j.ypmed.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/28/2015] [Accepted: 12/06/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Guidelines recommend initiating primary prevention with statins to those at highest cardiovascular risk. We assessed the gender-specific implementation and effectiveness of this risk-guided approach. METHODS We identified 1399 consecutive patients without known cardiovascular disease or diabetes hospitalized with a first myocardial infarction (MI) in Denmark. Statin use before MI was assessed, and cardiovascular risk was calculated using SCORE (Systematic COronary Risk Evaluation). RESULTS Among patients with first MI, 36% were women. Compared with men, they were older (mean 72 vs. 65years) but had a lower estimated risk (median 3.4% vs. 6.7%, SCORE high-risk model in the statin-naïve patients). Statin therapy had been initiated in 12% of women and 10% of men prior to MI. After adding 1.5mmol/L to the total cholesterol concentration of those already on statins, the estimated pre-treatment risk was much lower in women than men (median 3.8% vs. 9.2%, SCORE high-risk model), and only 29% of women would have passed the risk-based treatment threshold defined by the European guidelines (SCORE ≥5%). Estimated risk and statin use correlated directly in men but not in women. Only ~5% of first MI are prevented by the current use of statins in people without diabetes. CONCLUSION In people destined for a first MI, statin therapy is uncommon and prevents few events. Lower-risk women receive as much statins as higher risk men. This gender disparity and inefficient targeting of statins to those at highest risk indicate that risk scoring is not widely used in routine clinical practice in Denmark.
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Affiliation(s)
- Imra Kulenovic
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | | | - Ole May
- Department of Medicine, Regional Hospital Herning, Denmark
| | - Karen Kaae Dodt
- Department of Cardiology, Regional Hospital Horsens, Denmark
| | - Helle Kanstrup
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Erling Falk
- Department of Cardiology, Aarhus University Hospital, Denmark
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Prevalence of statin-drug interactions in older people: a systematic review. Eur J Clin Pharmacol 2016; 72:513-21. [PMID: 26790666 DOI: 10.1007/s00228-016-2011-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Statins are among the most frequently prescribed medications internationally. Older people are commonly prescribed multiple medications and are at an increased risk of drug-drug interactions, including statin-drug interactions. The aim of this study was to conduct a systematic review of current evidence on the prevalence of statin-drug interactions in older people. METHODS A systematic search of observational studies in Embase, Medline, and PubMed was conducted. Articles were included if they were published in English during the period July 2000-July 2014 and reported on the prevalence of statin-drug interactions in people over 65 years of age. Two reviewers independently assessed the articles for eligibility and extracted the data. RESULTS The search returned 1556 eligible articles. A total of 19 articles met the inclusion criteria. In studies (n = 7) that focused on statin users only, the prevalence of potential statin-drug interactions assessed using different measures ranged from 0.19 to 33.0 %. In studies that examined drug interactions across a population of both statin users and non-users (n = 12), the prevalence of potential statin-drug interactions ranged from 0.1 to 7.1 % (n = 8), and the prevalence of clinically relevant statin-drug interactions ranged from 1.5 to 4 % (n = 4). CONCLUSIONS Current published evidence suggests substantial variations in the prevalence of statin-drug interactions and their clinical relevance. Further studies are necessary to provide a better understanding of the prevalence of clinically significant statin-drug interactions, the medications most frequently contributing to statin-drug interactions, and impact on relevant clinical outcomes in older people.
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Izadpanah R, Schächtele DJ, Pfnür AB, Lin D, Slakey DP, Kadowitz PJ, Alt EU. The impact of statins on biological characteristics of stem cells provides a novel explanation for their pleiotropic beneficial and adverse clinical effects. Am J Physiol Cell Physiol 2015. [DOI: 10.1152/ajpcell.00406.2014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Statins reduce atherosclerotic events and cardiovascular mortality. Their side effects include memory loss, myopathy, cataract formation, and increased risk of diabetes. As cardiovascular mortality relates to plaque instability, which depends on the integrity of the fibrous cap, we hypothesize that the inhibition of the potential of mesenchymal stem cells (MSCs) to differentiate into macrophages would help to explain the long known, but less understood “non-lipid-associated” or pleiotropic benefit of statins on cardiovascular mortality. In the present investigation, MSCs were treated with atorvastatin or pravastatin at clinically relevant concentrations and their proliferation, differentiation potential, and gene expression profile were assessed. Both types of statins reduced the overall growth rate of MSCs. Especially, statins reduced the potential of MSCs to differentiate into macrophages while they exhibited no direct effect on macrophage function. These findings suggest that the limited capacity of MSCs to differentiate into macrophages could possibly result in decreased macrophage density within the arterial plaque, reduced inflammation, and subsequently enhance plaque stability. This would explain the non-lipid-associated reduction in cardiovascular events. On a negative side, statins impaired the osteogenic and chondrogenic differentiation potential of MSCs and increased cell senescence and apoptosis, as indicated by upregulation of p16, p53 and Caspase 3, 8, and 9. Statins also impaired the expression of DNA repair genes, including XRCC4, XRCC6, and Apex1. While the effect on macrophage differentiation explains the beneficial side of statins, their impact on other biologic properties of stem cells provides a novel explanation for their adverse clinical effects.
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Affiliation(s)
- Reza Izadpanah
- Applied Stem Cell Laboratory, Heart and Vascular Institute, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
- Department of Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana; and
| | - Deborah J. Schächtele
- Applied Stem Cell Laboratory, Heart and Vascular Institute, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Andreas B. Pfnür
- Applied Stem Cell Laboratory, Heart and Vascular Institute, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Dong Lin
- Applied Stem Cell Laboratory, Heart and Vascular Institute, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Douglas P. Slakey
- Department of Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana; and
| | - Philip J. Kadowitz
- Department of Pharmacology, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Eckhard U. Alt
- Applied Stem Cell Laboratory, Heart and Vascular Institute, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
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Gnjidic D, Wilson N, March L, Cumming RG, Cameron ID, Hilmer SN. Statin utilisation patterns in older Australians living in residential care: 1-year prevalence study. Intern Med J 2015; 45:106-9. [PMID: 25582939 DOI: 10.1111/imj.12633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/13/2014] [Indexed: 11/29/2022]
Abstract
Despite controversy over the risks and benefits of statin therapy, statins continue to be commonly used medicines by older people. In a cohort study of participants aged ≥70 years (n = 540) living in residential care, Sydney, we found that the proportion of statin users decreased gradually from the baseline of 33.1% to 31.3% at 6 months (P = 0.13) and to 28.7% over 1 year (P = 0.002). Prevalence of statin use decreased with increasing age, with individuals aged ≥90 years being more likely to discontinue or deprescribe statins. The patterns of statin use did not change according to increasing baseline dose or baseline indication.
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Affiliation(s)
- D Gnjidic
- Faculty of Pharmacy, Sydney Medical School, Sydney, New South Wales, Australia; Royal North Shore Hospital and Kolling Institute of Medical Research, Sydney Medical School, Sydney, New South Wales, Australia
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The impact of changes in national prescribing conditions for statins on their public expenditure and utilization in the Czech Republic 1997–2013. Health Policy 2015; 119:1255-64. [DOI: 10.1016/j.healthpol.2015.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 11/22/2022]
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Alzuhairi KS, Søgaard P, Ravkilde J, Gislason G, Køber L, Torp-Pedersen C. Incidence and outcome of first myocardial infarction according to gender and age in Denmark over a 35-year period (1978-2012). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2015; 1:72-78. [PMID: 29474597 DOI: 10.1093/ehjqcco/qcv016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Indexed: 12/31/2022]
Abstract
Aims To examine temporal changes in incidence and 1-year mortality of first myocardial infarction (MI) in different age groups for both genders in Denmark over a 35-year period (1978-2012). Methods and results Patients aged 30 years or older admitted with first MI in Denmark from 1978 to 2012 were included (n = 316 790). Overall, first MI incidence per 100 000 person-years (/105 p.y.) decreased significantly from 500 to 297/105 p.y. for males and from 229 to 156/105 p.y. for females. The decline was greatest among men aged 70-79 from 1460 to 643/105 p.y. (-56%). The majority of age groups also experienced declining incidence. However, men aged 30-39 and ≥90 years as well as females aged 30-49 and ≥90 years had increasing incidence during the study period. Moreover, the incidence decreased from 1978 to 1996 among males aged 40-49 and females aged 50-59 years, but increased in the remainder of the study period. One-year case-fatality declined significantly from 50 to 9% of MI male patients, and from 53 to 15% of MI female patients when comparing 1978 to 2012. Statistical analysis with Poisson models demonstrated that the mortality rate increased with age and decreased with time and indicated no significant difference between genders. Conclusions During the period from 1978 to 2012, there was a significant decline in MI incidence among most age groups for both genders; however, an incidence increase was observed in men under 50 and women under 60 years, and ≥90 years for both genders. One-year case-fatality decreased constantly during the study period.
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Affiliation(s)
- Karam Sadoon Alzuhairi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, Aalborg DK-9000, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, Aalborg DK-9000, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, Aalborg DK-9000, Denmark
| | - Gunnar Gislason
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Lavikainen P, Korhonen MJ, Huupponen R, Helin-Salmivaara A. Accumulation of cardiovascular and diabetes medication among apparently healthy statin initiators. PLoS One 2015; 10:e0117182. [PMID: 25658919 PMCID: PMC4319777 DOI: 10.1371/journal.pone.0117182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/20/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To characterize accumulation of drug-modifiable cardiovascular (CV) risk factors in statin initiators who had no prior medication or hospitalizations for CV disease or diabetes. Methods A cohort of 45-75-year-old statin initiators in Finland with no prior CV diseases, diabetes or medication for these conditions was followed up for 24 months after statin initiation for accumulation of CV and diabetes drugs. The number of drugs was measured semi-annually since the first statin purchase and analyzed by growth mixture modeling. Results Of the 11 948 apparently healthy statin initiators, 34% purchased at least one additional CV or diabetes drug during the subsequent 24 months. Of those, 20% redeemed no other CV or diabetes drugs at statin initiation but started to accumulate them after 18 months of follow-up, receiving on average 1.3 other drugs at 24 months. The majority, 59%, redeemed on average 0.5 drugs at statin initiation and accumulated 1.5 drugs by the end of 24-month follow-up. Seventeen percent received 1 additional drug at statin initiation, accumulating on average 3 drugs. The remaining 4% with an average of 2 CV or diabetes drugs at statin initiation redeemed 3.5 additional drugs during the follow-up. Conclusions Two years after statin initiation, 2 in 3 apparently healthy initiators could still be defined as such as reflected by CV and diabetes medication use.
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Affiliation(s)
- Piia Lavikainen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Drug Research Doctoral Programme, University of Turku, Turku, Finland
- * E-mail:
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Unit of Primary Health Care, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
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Upmeier E, Korhonen MJ, Rikala M, Helin-Salmivaara A, Huupponen R. Older Statin Initiators in Finland—Cardiovascular Risk Profiles and Persistence of Use. Cardiovasc Drugs Ther 2014; 28:263-72. [DOI: 10.1007/s10557-014-6517-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Trends in statin therapy initiation during the period 2000-2010 in Israel. Eur J Clin Pharmacol 2014; 70:557-64. [PMID: 24463538 DOI: 10.1007/s00228-013-1637-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/29/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this population-based study is to describe trends in the characteristics and treatment patterns of statin initiators over the first decade of the 21st century. METHODS New statin use was studied retrospectively using the database of Maccabi Healthcare Services (MHS), a large Israeli health maintenance organization. Statin initiators were defined as MHS members aged ≥ 30 years who first purchased statins between 2000 and 2010. The starting dose was calculated in simvastatin equivalents based on the World Health Organization's daily defined dose index. Persistence was calculated as the percentage of days covered (PDC) with statins during the first year of therapy. RESULTS Statin initiation peaked in 2005 and decreased from 38.6 to 18.6 per 1,000 in the period 2005-2010. The average age at therapy initiation decreased from 58.9 (± 12.0) to 54.5 (± 11.7) years, and the average (SD) baseline low-density lipoprotein cholesterol (LDL-C) decreased from 4.2 (± 1.1) to 4.0 (± 0.9) mmol/l during the study period. Women were on average 3 years older than men at treatment initiation, with a higher baseline LDL-C. Among statin initiators, the prevalence of ischemic heart disease (IHD) decreased from 17.8 to 6.7 %, and diabetes prevalence increased from 8.6 to 15.7 %, peaking in 2008 (18.0 %). The PDC with statins ranged between 52.9 and 57.7 %. Simvastatin use at initiation increased from 27.5 % in 2000 to >90 % since 2002. Starting dose increased from 18.5 (± 8.9) to 24.3 (± 13.7) mg simvastatin equivalent. CONCLUSIONS Among the study population, statin initiators were increasingly characterized by a lower cardiovascular risk-namely, younger individuals without IHD and with a lower baseline LDL-C. These trends underscore the important shift towards statin initiation for primary prevention, as well as the need to balance between benefits and the potential side effect of statins.
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Strandberg TE, Kurimo P, Kolehmainen L, Strandberg AY, Pitkälä KH, Tilvis RS. Midlife characteristics of older men using statins. J Am Geriatr Soc 2013; 61:831-2. [PMID: 23672552 DOI: 10.1111/jgs.12229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rikala M, Huupponen R, Helin-Salmivaara A, Korhonen MJ. Channelling of Statin Use towards Low-Risk Population and Patients with Diabetes. Basic Clin Pharmacol Toxicol 2013; 113:173-8. [DOI: 10.1111/bcpt.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Rikala
- Department of Pharmacology, Drug Development and Therapeutics; University of Turku; Turku; Finland
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