Undertreatment and overtreatment with statins: the Oslo Health Study 2000–2001

Abstract

Results. Of subjects with a heart attack, angina, stroke or diabetes 45% of men and 35% of women were taking a statin (P < 0.001). Of subjects with cardiovascular disease (CVD) or diabetes taking statins 61% of men and 40% of women achieved total serum cholesterol levels £5 mmol L )1 . The odds ratio for taking a statin was increased amongst subjects who also took antihypertensive drug(s) or acetylsalicylic acid, subjects with a family history of coronary heart disease (CHD) and women who had visited the general practitioner within the last year. Amongst presumed healthy subjects use of statins increased from about 1% in women aged 40-45 years, to 7% at age 60 and to 12% at age 75 whilst the corresponding figures for men were 3%, 8% and 9%, respectively. About 22% of men but <2% of women aged 60 who were not taking statins had a 10-year Framingham CHD risk score >20%. Determinants of statin use were similar to those amongst subjects with CVD or diabetes. Conclusion. People with CVD or diabetes remain undertreated with statins, women more so than men. Use of other preventive drugs, the family history and recent contact with the general practitioner were the most important determinants of statin use in primary and secondary prevention. Amongst healthy subjects aged 60 or 75 years women received statins disproportionately to their low CHD risk compared with men.

State and self investments in health

“…In line with the results of Reid et al (2002) and Ramsay et al (2005), they find that the young and people with a history of myocardial infarction are those, amongst the patients with heart disease, more likely to be taking lipid-regulating drugs. Undertreatment with lipid-lowering drugs amongst older people and women has been highlighted by Tonstad et al (2004) in the Oslo Health Study and by Ma et al (2005) in the U.S. National Ambulatory Medical Care Survey. Other studies find that doctor's prescription of lipid-lowering drugs is related to the socioeconomic status (SES) of the patient (Scott et al, 1996;Ohlsson et al, 2010).…”

The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study

“…In most societies men are better educated, have higher positions in society, are more financially independent and take greater control of decision making than women. Several studies have shown that men with diabetes and CVD are more likely than women with comparable conditions to receive more intensive medical treatments such as statins, antihypertensive drugs and acetylsalicylates [26,39], which would be expected to lead to better treatment outcomes. As we provided a focused, structured and personalised intervention for both men and women, quality of care could be assumed to be similar in both groups.…”

Why do sales of lipid-lowering drugs vary between counties in Norway?

“…Furthermore, the prevalence of LLD use depends on the extent to which treatment-eligible individuals are treated in clinical practice. There is documented a gap between guidelines for cholesterol management and clinical practice [20,21]. Variations in treatment intensity, i.e.…”