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Increasing statin usage not associated with decreasing coronary heart disease mortality
Monday, March 27, 2017 12:54 pm Email this article
“Among the [twelve (12)] Western European countries studied, the large increase in statin utilisation between 2000 and 2012 was not associated with [coronary heart disease] mortality, nor with its rate of change over the years,” notes a recent study.
The authors of the paper wrote:
“There was no statistically signiﬁcant correlation between statin utilisation and CHD [coronary heart disease] mortality in any of the years between 2000 and 2012.
“No signiﬁcant relation was found between changes in statin utilisation between 2000 and 2012 on the one hand, and the changes in CHD [coronary heart disease] mortality over the same period on the other hand.
“However, when the different countries were compared, there was no evidence that higher statin utilisation was associated with lower CHD [coronary heart disease] mortality, nor was there evidence that a high increase in statin utilisation between 2000 and 2012 was related to a larger reduction in CHD [coronary heart disease] mortality.
“The overall reduced CHD [coronary heart disease] mortality might be considered as an effect of the increased utilisation of statins.
“Although several clinical studies have demonstrated that statins reduce the cardiovascular mortality in primary and secondary prevention, the decrease in CHD [coronary heart disease] mortality rates in Western countries started well before statin therapy became available, due to improvement of risk factors, as a result of population-based interventions.
“Moreover, clinical trials in primary and secondary prevention show that statins lower the absolute risk of coronary death by less than 1–3.5%, which represents a small proportion of the observed reduction.
“Consequently, it is difﬁcult to demonstrate any population impact of statin utilisation on CHD mortality.
“This was conﬁrmed in a Swedish study including a large sample of municipalities, where no correlation was shown between statin utilisation and acute myocardial infarction incidence or mortality.
“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.
“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.”
The countries studied included Finland, Scotland, Germany, Sweden, Norway, Denmark, the Netherlands, Italy, Belgium, Spain, Portugal and France.
Vancheri F, Backlund L, Strender LE, Godman B, and Wettermark B. Time trends in statin utilisation and coronary mortality in Western European countries. BMJ Open, 2016 Mar 30; 6(3): e010500.
Author’s Contact Info
Dr Federico Vancheri
Department of Neurobiology
Care Sciences and Society
Division of Family Medicine
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