A 10-Year Trend in Statin Use Among Older Adults in Australia: an Analysis Using National Pharmacy Claims Data

Ofori‐Asenso, Richard; Ilomäki, Jenni; Zomer, Ella; Curtis, Andrea J.; Zoungas, Sophia

doi:10.1007/s10557-018-6794-x

Cited by 27 publications

(22 citation statements)

References 44 publications

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“…However, for primary prevention with statins, recommendations in clinical guidelines from different countries are inconsistent in adults aged 65-75 years and are generally lacking in those aged 75 years and older, who have been largely underrepresented in clinical trials [2,3]. Despite this, there has been a marked increase of statin prescriptions for primary prevention in older adults over the past decade, owing to their higher disease burden and poorer outcomes following a first cardiovascular event [4][5][6]. The widespread use of statins in this subpopulation has raised great concerns about potential statin-related risks, upon which the clinical trial evidence is weak and limited [7].…”

Section: Introductionmentioning

confidence: 99%

The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults: A Systematic Review and Meta-analysis

et al. 2020

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Introduction The use of statins for primary prevention of cardiovascular disease (CVD) is increasing in older adults. Nonetheless, good clinical evidence for the safety and tolerability of statins in this population is limited. Objective We aimed to evaluate the safety and tolerability of statins in older adults without overt CVD, with focus on statin-related muscle symptoms. Methods Double-blinded randomised controlled trials (RCTs) of statins published before January 2012 were identified from a Cochrane review updated to 2012. Trials published between January 2012 to July 2018 were identified through the CENTRAL, MEDLINE and EMBASE databases. Eligible trials were limited to those including individuals aged ≥ 65 years without overt CVD, who were followed for at least one year. Trials should report at least one of the outcomes of interest. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the random-effects models. Results Eleven trials including 18,192 participants were identified (mean age 73.7 years; 43% females). Compared with placebo, statins neither increase the risks of muscle-related symptoms (RR 1.01; 95% CI 0.90 to 1.12), total adverse events (AEs) and serious AEs nor lead to more total permanent treatment discontinuations and discontinuations due to AEs or specifically due to muscle-related symptoms. No evidence of heterogeneity was observed in any of these outcomes. Conclusions This meta-analysis of RCTs found no excess incidence of muscle-related symptoms, total AEs, serious AEs and treatment discontinuations attributable to statin compared with placebo among older adults without CVD.

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Section: Introductionmentioning

confidence: 99%

The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults: A Systematic Review and Meta-analysis

et al. 2020

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“…Statins (hydroxymethylglutaryl‐CoA reductase inhibitors) are one of the most commonly prescribed pharmacotherapies for the prevention and treatment of cardiovascular disease (CVD) , and their use has increased over the past decades. In Australia, 34.2% of adults aged 65 years and over were dispensed statins in 2007 and this proportion increased to 44.1% in 2016 . This translates into a 29% increased likelihood of being dispensed a statin in 2016 compared to 2007 (incidence rate ratio 1.29, 95% confidence interval [CI] 1.28–1.31) .…”

Section: Introductionmentioning

confidence: 99%

“…In Australia, 34.2% of adults aged 65 years and over were dispensed statins in 2007 and this proportion increased to 44.1% in 2016 . This translates into a 29% increased likelihood of being dispensed a statin in 2016 compared to 2007 (incidence rate ratio 1.29, 95% confidence interval [CI] 1.28–1.31) .…”

Section: Introductionmentioning

confidence: 99%

Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Ofori‐Asenso

Ilomäki

Tacey

et al. 2018

Brit J Clinical Pharma

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Aims The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. Methods Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first‐year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co‐payment; n = 4841) and concessional beneficiaries (with a lower co‐payment; n = 17 499). Results During the one‐year follow‐up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75–84 years and ≥85 years were more likely to discontinue than people aged 65–74 years (odds ratio 1.11, 95% confidence interval 1.04–1.19 and 1.38, 1.23–1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. Conclusions Among older adults prescribed statins, first‐year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.

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“…Finally, changes in the patterns of statins use, such as the increase in their prescription for primary prevention 46,47 and the use of high-potency statins, 48,49 were unlikely to have influenced the results of our study. Spanish blood lipid national and local guidelines advise no systematic prescription of statins and the overall management of the cardiovascular risk and, when recommended, low and moderate statins should be the first choice.…”

Section: Strengths and Limitationsmentioning

confidence: 92%

Effectiveness of Statins as Primary Prevention in People With Gout: A Population-Based Cohort Study

García-Gil

Comas-Cufí

Ramos

et al. 2019

J Cardiovasc Pharmacol Ther

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Background: Cardiovascular guidelines do not give firm recommendations on statin therapy in patients with gout because evidence is lacking. Aim: To analyze the effectiveness of statin therapy in primary prevention of coronary heart disease (CHD), ischemic stroke (IS), and all-cause mortality in a population with gout. Methods: A retrospective cohort study (July 2006 to December 2017) based on Information System for the Development of Research in Primary Care (SIDIAPQ), a research-quality database of electronic medical records, included primary care patients (aged 35-85 years) without previous cardiovascular disease (CVD). Participants were categorized as nonusers or new users of statins (defined as receiving statins for the first time during the study period). Index date was first statin invoicing for new users and randomly assigned to nonusers. The groups were compared for the incidence of CHD, IS, and all-cause mortality, using Cox proportional hazards modeling adjusted for propensity score. Results: Between July 2006 and December 2008, 8018 individuals were included; 736 (9.1%) were new users of statins. Median follow-up was 9.8 years. Crude incidence of CHD was 8.16 (95% confidence interval [CI]: 6.25-10.65) and 6.56 (95% CI: 5.85-7.36) events per 1000 person-years in new users and nonusers, respectively. Hazard ratios were 0.84 (95% CI: 0.60-1.19) for CHD, 0.68 (0.44-1.05) for IS, and 0.87 (0.67-1.12) for all-cause mortality. Hazard for diabetes was 1.27 (0.99-1.63). Conclusions: Statin therapy was not associated with a clinically significant decrease in CHD. Despite higher risk of CVD in gout populations compared to general population, patients with gout from a primary prevention population with a low-to-intermediate incidence of CHD should be evaluated according to their cardiovascular risk assessment, lifestyle recommendations, and preferences, in line with recent European League Against Rheumatism recommendations.

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A 10-Year Trend in Statin Use Among Older Adults in Australia: an Analysis Using National Pharmacy Claims Data

Cited by 27 publications

References 44 publications

The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults: A Systematic Review and Meta-analysis

The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults: A Systematic Review and Meta-analysis

Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Effectiveness of Statins as Primary Prevention in People With Gout: A Population-Based Cohort Study

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