Statin prescription patterns, adherence, and attainment of cholesterol treatment goals in routine clinical care: a Danish population-based study

Abstract

PurposeTo examine the annual rate and cumulative prevalence of statin use in Denmark 2004–10, including adherence of use and attainment of cholesterol targets.MethodsWe included all individuals aged 18–86 years with a first statin prescription in Northern Denmark in 2004–10. We calculated the annual rate and cumulative prevalence of statin use. We examined cholesterol values before and after start of statins and the proportion reaching targets according to European guidelines and cardiovascular risk group.ResultsThe study population consisted of 161,646 new statin users (51% men; median age 62 years). The peak rate of new statin initiators occurred in 2008, and a cumulative prevalence of 94 users per 1,000 population was reached in 2010. In total, 98% of new users started with simvastatin. Eighty-eight percent (142,897) did not switch statin type during follow-up. Overall persistence was 84%. The reduction in median total cholesterol in new statin users was 28% (from 6.3 mmol/L to 4.5 mmol/L), while it was 43% (from 4.0 mmol/L to 2.3 mmol/L) for low-density lipoprotein cholesterol. Among patients with very high cardiovascular risk, 66% attained the recommended total cholesterol target; corresponding figures were 74% among high-risk patients and 80% among low- to moderate-risk patients. Corresponding figures for low-density lipoprotein cholesterol were 54%, 82%, and 88%, respectively.ConclusionsStatin use has become very prevalent in Danish adults, with high adherence. Cholesterol reduction after statin initiation is similar to that found in clinical trials, yet a substantial proportion of patients does not reach target cholesterol levels.

Predictors of first-year statin medication discontinuation: A cohort study

“…The rate of discontinuation was 12%, which is within the range reported earlier 2, 3, 6, 10, 11, 41, 42. Some previous studies have found that patients with cardiovascular comorbidities are less likely to discontinue statin use than those free of such comorbidities 3, 20, 43.…”

“…Some previous studies have found that patients with cardiovascular comorbidities are less likely to discontinue statin use than those free of such comorbidities 3, 20, 43. However, a recent Danish, population-based study of 161, 646 new statin users reported discontinuers to have a slightly higher prevalence of almost all the examined diagnoses of comorbidity, including cardiovascular disease 11 . A major limitation of that study was its reliance on registered data only.…”

“…Despite these well-documented benefits, poor adherence to statins and an extreme form of it, discontinuation—that is, quitting statin medication use 2 —is common among primary and secondary prevention patients 3, 4, 5, 6. In clinical trials, the discontinuation rates range from 4% to 11%,7, 8, 9 but in routine care, the rates are much higher; between 11% and 53% 2, 3, 10, 11. According to studies using electronic medical records, approximately 25% to 50% of patients discontinue statin use within six months to one year after initiating their use 4, 5, 12.…”

Validating registry data on statins prescriptions by blood measurements

“…That said, it is also possible that cancer patients would be distracted from taking medications directed at cardiovascular disease, in which case these results might underestimate adherence in an otherwise healthy population. We found the same medication possession ratio as reported in a population‐based study in the Northern Denmark, suggesting that our results may be widely generalizable.…”

Statins and New-Onset Diabetes in Cardiovascular and Kidney Disease Cohorts: A Meta-Analysis

“…Statins are one of the most commonly prescribed medications [1, 2]. Over 25% of Americans over the age of 45 years are prescribed a statin according to a CDC study from 2010 [3].…”