Time trends in statin utilization and coronary mortality in western European countries

Vancheri, Frederico and Backlund, Lars and Strender, Lars-Erik and Godman, Brian and Wettermark, Bjorn (2016) Time trends in statin utilization and coronary mortality in western European countries. BMJ Open, 6 (3). e010500. ISSN 2044-6055

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    Abstract

    Objectives. To determine whether there is a relation between statin utilization and coronary heart disease (CHD) mortality in populations with different levels of coronary risk, and whether the relation changes over time. Design. Ecological study using national databases on dispensed medicines and mortality rates. Setting. Western European countries with similar public health systems. Main outcome measures. Population CHD mortality rates (rate/100.000) as a proxy for population coronary risk level, and statin utilization expressed as Defined Daily Dose per one Thousand Inhabitants per Day (DDD/TID), in each country, for each year between 2000 and 2012. Pearson’s correlation coefficients between CHD mortality and statin utilization were calculated. Linear regression analysis was used to assess the relation between changes in CHD mortality and statin utilization over the years. Results. Twelve countries were included in the study. There was a wide range of CHD mortality reduction between the years 2000 and 2012 (from 25.9% in Italy to 57.9% in Denmark) and statin utilization increase (from 121% in Belgium to 1,263% in Denmark). No statistically significant relations were found between CHD mortality rates and statin utilization, nor between changes in CHD and changes in statin utilization in the countries over the years 2000 and 2012. Conclusions. Among the Western European countries studied, the large increase in statin utilization between 2000 and 2012 was not associated with CHD mortality, nor with its rate of change over the years. Factors different from the individual coronary risk, such as population ageing, health authority programs, guidelines, media attention and pharmaceutical industry marketing, may have influenced the large increase in statin utilization. These need to be re-examined with a greater emphasis on prevention strategies.