Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials

Li, Wei; Ebrahim, Shah; Bartlett, C. J.; Davey, Peter; Sullivan, Frank; MacDonald, Thomas M.

doi:10.1136/bmj.38398.408032.8f

Cited by 81 publications

(43 citation statements)

References 21 publications

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“…This finding is in agreement with previous studies describing disappointing levels of primary care prescribing in DM and for primary and secondary prevention of CV disease [16,17,18,19,20]. In England, the Quality and Outcomes Framework rewards primary care for the appropriate use of statins and aspirin in relevant conditions, and providing such financial incentives has been shown to be effective in the management of DM [21].…”

Section: Discussionsupporting

confidence: 82%

“…The current analysis indicates room for substantial improvement in prescribing for management of CV risk in CKD. Established CVD, DM and HTN are all well-established factors that influence aspirin and statin prescriptions for the purpose of reducing CVD events [16,20]. The low prescription rates for statins and aspirin in uncomplicated CKD, compared to CKD associated with DM, CV disease and/or hypertension in the current study suggests that CKD is not widely regarded as a key risk factor for CV disease in its own right.…”

Section: Discussionmentioning

confidence: 79%

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Prescription Rates of Cardiovascular Medications in a Large UK Primary Care Chronic Kidney Disease Cohort

Major

Shepherd

Warwick

et al. 2016

Nephron

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Background and Aims: Chronic kidney disease (CKD) is associated with increased cardiovascular (CV) risk. Guidelines have suggested the universal use of statins in CKD but aspirin's role is less well defined. The aim of this study was to determine prescription rates for statins and aspirin in a UK-based CKD cohort and to establish factors that influenced prescription rates. Methods: We used data from a UK primary care CKD cohort to study rates of prescription of statins and aspirin. Simple rates were initially calculated. Binary logistic regression was utilized with either statin or aspirin prescription as the outcome variable and covariates including demographic details and comorbidities. Results: There were 31,056 individuals in the cohort with at least one estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m², and 65.1% individuals had 2 eGFR results <60 ml/min/1.73 m² more than 3 months apart. Mean eGFR at baseline was 51.1 ml/min/1.73 m² (SD 9.1), and 64.9% had a diagnosis of hypertension (HTN), 18.8% had diabetes mellitus (DM) and 29.8% a history of CV disease. Statins were prescribed to 14,972 (48.2%) and aspirin to 11,023 (35.5%). The regression model suggested that CV disease, HTN and DM influenced the prescriptions of statins and aspirin but overall CKD stage, calculated by either eGFR or proteinuria, did not. Conclusions: Prescriptions of statins and aspirin in CKD is based more on the presence of comorbidities than the CKD severity. Further physician and patient education of the increased CV risk associated with CKD and its suitability for CV medication intervention is required.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 79%

Prescription Rates of Cardiovascular Medications in a Large UK Primary Care Chronic Kidney Disease Cohort

Major

Shepherd

Warwick

et al. 2016

Nephron

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“…However, our observational study showed a reduction of 1.41 mmol/L (SD 1.29), which was similar to that found in a population level study [12]. This better outcome could be due to patient characteristic differences [34]. Our metaanalysis also found that the mean TC increased by 0.01 mmol/L (5.92 mmol/L minus 5.91 mmol/L) in the placebo-treated patients at the end of follow-up in trials.…”

Section: Key Findingssupporting

confidence: 62%

Statins and total (not LDL) cholesterol concentration and outcome of myocardial infarction: results from a meta-analysis and an observational study

Sheng

Murphy

et al. 2009

Eur J Clin Pharmacol

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“…In modern clinical practice, analyzing drug utilization is an important tool for achieving rational drug therapy in any clinical setting [9][10][11][12]. It is necessary for identification of a problem, and for following effectiveness of corrective interventions, undertaken by management of a health facility.…”

Section: Discussionmentioning

confidence: 99%

Antihypertensive drugs utilisation and educational activities

Veličković‐Radovanović¹,

Petrović²,

Kodela

et al. 2010

Open Medicine

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AbstractThe mortality rate from cardiovascular diseases is high in Serbia. Analysis of antihypertensive drugs utilization is the basis for assessment of cardiovascular pharmacotherapy appropriateness. The aim of this study was to analyze the trend in antihypertensive drugs utilization among outpatients in Niš region, South Serbia compared to some Nordic countries (Norvay, Sweden) and Australia as well as to analyze trends in educational and drug promotion activities directed to primary healthcare workers within the same region. Using the ATC/DDD methodology, we analyzed the utilization of antihypertensive drugs dispensed on prescription in the Nis region over the 2003–2007 period. The study was retrospective, based on data obtained from Central City Pharmacy Nis. Educational and drug promotion activities were noted from the records of Medical Faculty, University of Nis, and from the records of local branches of pharmaceutical companies active in Serbia. Wilcoxon’s test was used in order to calculate the statistical significance of difference. A significant increase of 79.8% (153.8/ 276.6 DDD/inhabitants/day) in antihypertensive drug consumption was observed in the same period. This analysis showed there were substantial increases in the use of diuretics (134.7%), ACE inhibitors (79.5%) and calcium channel blockers (116.1%), especially amlodipin (241.2%). During the observed period, annual numbers of educational activities and of pharmaceutical sales representatives employed within the region increased for almost one fourth. This analysis pointed to a significant increase in the use of antihypertensive drugs in the Nis region, which was matched with increase in educational and drug promotion activities within the region, so that in 2006–2007 total consumption was approximate to some referential countries (Norvay, Sweden).

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Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials

Cited by 81 publications

References 21 publications

Prescription Rates of Cardiovascular Medications in a Large UK Primary Care Chronic Kidney Disease Cohort

Prescription Rates of Cardiovascular Medications in a Large UK Primary Care Chronic Kidney Disease Cohort

Statins and total (not LDL) cholesterol concentration and outcome of myocardial infarction: results from a meta-analysis and an observational study

Antihypertensive drugs utilisation and educational activities

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