European Journal of Clinical Pharmacology

, Volume 69, Issue 2, pp 261–267 | Cite as

Statin use among older Finns stratified according to cardiovascular risk

  • Eveliina Upmeier
  • Maarit Jaana KorhonenEmail author
  • Arja Helin-Salmivaara
  • Risto Huupponen
Pharmacoepidemiology and Prescription



Statin use has increased in older age groups, although there is little evidence for the benefits of statin therapy in the elderly, especially in low-risk persons. The aim of this paper is to describe recent trends in the prevalence and incidence of statin use among the Finnish older population, according to the person’s estimated cardiovascular (CV) event risk.


We conducted a register study covering the whole community-dwelling population of Finland, aged >70 years in 2000–2008 (N = 883,051). Data on reimbursed purchases of statins, antidiabetic and CV drugs, and pre-existing CV diseases were retrieved from comprehensive national registers. We stratified each person into low, moderate or high CV risk category, and according to age (70–74, 75–79, and >80 years) and sex.


Between 2000 and 2008, the age-sex-standardized prevalence of statin use tripled from 12.2 % to 38.7 % (rate ratio 3.0, 95 % CI 3.0–3.1), and the incidence almost doubled (from 3.7 % to 6.8 %; rate ratio 1.8, 95 % CI 1.8–1.9). The prevalence and incidence of statin use were consistently highest among high-risk persons. The greatest relative increases were observed in persons aged >80 years and in those at low risk; however, the proportion of statin users at low CV risk remained the same (∼7 % of all users).


Statin prescribing is shifting towards older age groups. A substantial increase in prevalence and incidence was seen across all risk categories, but the channeling of statin use towards high-risk persons remained unchanged.


Statins Elderly Prevalence Incidence Cardiovascular risk 



This study was financially supported by a research grant from the Social Insurance Institution of Finland (10/26/2007) and the Turku University Hospital Research Fund (EVO). Eveliina Upmeier was also supported by the research fund of Turku City Hospital (EVO).

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

228_2012_1328_MOESM1_ESM.pdf (250 kb)
Online Resource 1 Table 1. Annual prevalence (%) of statin use among older Finns by sex, cardiovascular risk category, and age, 2000─2008 (PDF 250 kb)
228_2012_1328_MOESM2_ESM.pdf (252 kb)
Online Resource 2 Table 2. Annual incidence (%) of statin use among older Finns by sex, cardiovascular risk category, and age, 2000─2008 (PDF 252 kb)


  1. 1.
    Walley T, Folino-Gallo P, Stphens P, Van Ganse E (2005) Trends in prescribing and utilization of statins and other lipid lowering drugs across Europe 1997-2003. Br J Clin Pharmacol 60:543–551PubMedCrossRefGoogle Scholar
  2. 2.
    Robinson J, Booth B (2010) Statin use and lipid levels in older adults: National Health and Nutrition Examination Survey, 2001 to 2006. J Clin Lipidol 4:483–490PubMedCrossRefGoogle Scholar
  3. 3.
    Grundy S, Cleeman J, Merz CN et al (2004) Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 110:227–239PubMedCrossRefGoogle Scholar
  4. 4.
    The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) (2011) ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J 32:1769–1818CrossRefGoogle Scholar
  5. 5.
    Redberg RF, Katz M, Grady D (2011) To make the case – Evidence is required. Arch Intern Med 171:1594PubMedCrossRefGoogle Scholar
  6. 6.
    Ridker PM, Danielson E, Fonseca FA, for the JUPITER Study Group et al (2008) Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 359:2195–2207PubMedCrossRefGoogle Scholar
  7. 7.
    Brugts JJ, Yetgin T, Hoeks SE et al (2009) The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 338:b2376PubMedCrossRefGoogle Scholar
  8. 8.
    Ray KK, Seshasai S, Erqou S et al (2010) Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med 170:1024–1031PubMedCrossRefGoogle Scholar
  9. 9.
    Taylor F, Ward K, Moore TH, et al (2011) Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 1:CD00481642Google Scholar
  10. 10.
    Miettinen TA, Pyörälä K, Olsson AG, for the Scandinavian Simvastatin Study Group et al (1997) Cholesterol-lowering therapy in women and elderly patients with myocardial infarction or angina pectoris. Findings from the Scandinavian Simvastatin Study (4S). Circulation 96:4211–4218PubMedCrossRefGoogle Scholar
  11. 11.
    Lewis SJ, Moye LA, Sacks FM et al (1998) Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range: results of the cholesterol and recurrent events (CARE) trial. Ann Intern Med 129:681–689PubMedGoogle Scholar
  12. 12.
    Heart Protection Study Collaborative Group (2002) MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 360:7–22CrossRefGoogle Scholar
  13. 13.
    Shephard J, Blauw GJ, Murphy MB et al (2002) Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 360:1623–1630CrossRefGoogle Scholar
  14. 14.
    Baigent C, Keech A, Kearney PM, Cholesterol Treatment Trialists' (CTT) Collaborators et al (2005) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 366:1267–1278PubMedCrossRefGoogle Scholar
  15. 15.
    Hunt D, Young P, Simes J, for the LIPID investigators et al (2001) Benefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients: Results from the LIPID trial. Ann Intern Med 134:931–940PubMedGoogle Scholar
  16. 16.
    Afilalo J, Duque G, Steele R, Jukema JW, de Craen AJ, Eisenberg MJ (2008) Statins for secondary prevention in elderly patients: a hierarchical Bayesian meta-analysis. J Am Coll Cardiol 51:37–45PubMedCrossRefGoogle Scholar
  17. 17.
    Ali R, Alexander KP (2007) Statins for the primary prevention of cardiovascular events in older adults: A review of the evidence. Am J Geriatr Pharmacother 5:52–63PubMedCrossRefGoogle Scholar
  18. 18.
    Robinson J, Bakris G, Torner J, Stone NJ, Wallace R (2007) Is it time for a cardiovascular primary prevention trial in the elderly? Stroke 38:441–450PubMedCrossRefGoogle Scholar
  19. 19.
    Petersen LK, Christensen K, Kragstrup J (2010) Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80 + -year olds. Age Ageing 39:674–680PubMedCrossRefGoogle Scholar
  20. 20.
    Huisman-Baron M, van der Veen L, Jansen PA, van Roon EN, Brouwers JR, van Marum RJ (2011) Criteria for drug selection in frail elderly persons. Drugs Aging 28:391–402PubMedCrossRefGoogle Scholar
  21. 21.
    Ruokoniemi P, Helin-Salmivaara A, Klaukka T, Neuvonen PJ, Huupponen R (2008) Shift of statin use towards the elderly in 1995-2005: a nationwide register study in Finland. Br J Clin Pharmacol 66:405–410PubMedCrossRefGoogle Scholar
  22. 22.
    Hjemdahl P, Allhammar A, Heaton C (2009) SBU should investigate what is an evidence-based and cost-effective use of statins. Lakartidningen 106:1992–1994PubMedGoogle Scholar
  23. 23.
    Kildemoes HW, Andersen M, Stovring H (2010) The impact of aging and changing utilization patterns on future cardiovascular drug expenditure: a pharmacoepidemiological projection approach. Pharmacoepidemiol Drug Saf 19:1276–1286PubMedCrossRefGoogle Scholar
  24. 24.
    Geleedst-De Vooght M, Maitland-van der Zee A-H, Schalekamp T, Mantel-Teeuwisse A, Jansen P (2010) Statin prescribing in the elderly in the Netherlands. A pharmacy database time trend study. Drugs Aging 27:589–596PubMedCrossRefGoogle Scholar
  25. 25.
    Setoguchi S, Glynn RJ, Avorn J, Levin R, Winkelmayer WC (2007) Ten-year trends of cardiovascular drug use after myocardial infarction among community-dwelling persons > or =65 years of age. Am J Cardiol 100:1061–1067PubMedCrossRefGoogle Scholar
  26. 26.
    Candrilli SD, Kuznik A, Mendys PM, Wilson DJ (2010) Prevalence and coexistence of cardiovascular comorbidities among the US dyslipidemic population aged >65 years by lipid-lowering medication use status. Postgrad Med 122:142–149PubMedCrossRefGoogle Scholar
  27. 27.
    DeWilde S, Carey IM, Bremmer SA, Richards N, Hilton SR, Cook DG (2003) Evolution of statin prescribing 1994-2001: a case of ageism but not sexism? Heart 89:417–421PubMedCrossRefGoogle Scholar
  28. 28.
    Korhonen MJ, Helin-Salmivaara A, Huupponen R (2011) Dynamics of long-term statin therapy. Eur J Clin Pharmacol 67:925–931PubMedCrossRefGoogle Scholar
  29. 29.
    Kildemoes HW, Hendriksen C, Andersen M (2011) Drug utilization according to reason for prescribing: a pharmacoepidemiologic method based on an indication hierarchy. Pharmacoepidemiol Drug. doi: 10.1002/pds.2039
  30. 30.
    Gränsbo K, Melander O, Wallentin L et al (2010) Cardiovascular and cancer mortality in very elderly post-myocardial infarction patients receiving statin treatment. J Am Coll Cardiol 55:1362–1369PubMedCrossRefGoogle Scholar
  31. 31.
    Carey I, DeWilde S, Shah SM, Harris T, Whincup PH, Cook DG (2010) Statin use after first myocardial infarction in UK men and women from 1997 to 2006: Who started and who continued treatment? Nutr Metab Cardiovasc Dis. doi: 10.1016/j.numecd.2010.09.10
  32. 32.
    Glynn RJ, Koenig W, Nordestgaard BG, Shephard J, Ridker PM (2010) Rosuvastatin for primary prevention in older persons with elevated c-reactive protein and low to average low-density lipoprotein cholesterol levels: Exploratory analysis of a randomized trial. Ann Intern Med 152:488–496PubMedGoogle Scholar
  33. 33.
    de Lorgeril M, Salen P, Abramson J et al (2010) Cholesterol lowering, cardiovascular diseases, and the rosuvastatin-JUPITER controversy. Arch Intern Med 170:1032–1036PubMedCrossRefGoogle Scholar
  34. 34.
    Helin-Salmivaara A, Lavikainen P, Korhonen MJ et al (2008) Long-term persistence with statin therapy: A nationwide register study in Finland. Clin Ther 30:2228–2240PubMedCrossRefGoogle Scholar
  35. 35.
    Ali RC, Melloni C, Ou F-S et al (2009) Age and persistent use of cardiovascular medication after acute coronary syndrome: Results from medication applied and sustained over time (MAINTAIN). J Am Geriatr Soc 57:1990–1996PubMedCrossRefGoogle Scholar
  36. 36.
    Upmeier E, Korhonen MJ, Helin-Salmivaara A, Huupponen R (2011) Statiinien käyttö yleistyy myös vanhimmissa ikäluokissa. Suom Lääkäril 66:1930–1933 [in Finnish]Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Eveliina Upmeier
    • 1
    • 2
    • 3
  • Maarit Jaana Korhonen
    • 1
    Email author
  • Arja Helin-Salmivaara
    • 1
    • 4
  • Risto Huupponen
    • 1
    • 2
  1. 1.Department of Pharmacology, Drug Development and TherapeuticsUniversity of TurkuTurkuFinland
  2. 2.Unit of Clinical PharmacologyTurku University HospitalTurkuFinland
  3. 3.Department of GeriatricsTurku City Hospital and Elderly Health ServicesTurkuFinland
  4. 4.Unit of General PracticeHospital District of Helsinki and UusimaaHelsinkiFinland

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