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European Journal of Clinical Pharmacology

, Volume 70, Issue 1, pp 99–108 | Cite as

Standard and intensive lipid-lowering therapy with statins for the primary prevention of vascular diseases: a population-based study

  • D. Macías Saint-GeronsEmail author
  • C. de la Fuente Honrubia
  • D. Montero Corominas
  • M. J. Gil
  • F. de Andrés-Trelles
  • F. Catalá-López
Pharmacoepidemiology and Prescription

Abstract

Purpose

To describe the clinical profile of the patients that initiate statin therapy for the primary prevention of vascular diseases and to investigate the extent to which clinicians use intensive vs. standard regimens.

Methods

A cross-sectional analysis of nationwide individual data regarding individuals ≥11 years with a first prescription of statin, recorded between 1 January 2007 and 31 December 2011. Subjects were defined as intensive therapy initiators if a statin dose superior to simvastatin 40 mg (or equivalent dose if different statin) was first prescribed. Multivariable logistic regression models were built for dependent summary variables to evaluate the strength of the association between them and the use of intensive therapy.

Results

Overall, 69,737 patients receiving a first prescription of statin for the primary prevention of vascular diseases were identified. Predictors for intensive therapy initiation were male gender (adjusted OR: 1.28; 95%CI: 1.10–1.48), history of hypothyroidism (1.47; 1.17–1.85), current treatment of diabetes (1.18; 1.00–1.41), proteinuria (1.87; 1.12–3.12), age, and year of statin prescription. Modifiable risk factors associated with intensive therapy were elevated tryglicerides (1.63; 1.39–1.91), elevated LDL-C (1.96; 1.69–2.28), obesity (1.25; 1.07–1.47), smoking (1.32; 1.14–1.55), comedication with ezetimibe (3.76; 1.87–7.55), fibrates (1.96; 1.43–2.70) and calcium antagonists in women (1.42; 1.02–1.98).

Conclusions

The use of intensive therapy with statins in primary prevention was not very high in absolute terms, but is increasing considerably. The association between intensive therapy and previous hypothyroidism or its combination with fibrates may raise additional safety and tolerability concerns.

Keywords

Pharmacoepidemiology Drug utilization study Hydroxymethylglutaryl-CoA reductase inhibitors Statin Intensive therapy Spain 

Notes

Acknowledgments

Authors would like to acknowledge the excellent collaboration of general practitioners taking part in BIFAP.

Funding

None.

Conflict of Interest Statement

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work and no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.

Contributions of Authors statement

All the authors have contributed substantially to the material and/or intellectual content, data analysis, if applicable, and the writing of the manuscript, sufficiently to accept public accountability for it.

Supplementary material

228_2013_1586_MOESM1_ESM.docx (29 kb)
ESM 1 (DOCX 28.7 KB)
228_2013_1586_MOESM2_ESM.doc (56 kb)
ESM 2 (DOC 55 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • D. Macías Saint-Gerons
    • 1
    Email author
  • C. de la Fuente Honrubia
    • 1
  • D. Montero Corominas
    • 1
  • M. J. Gil
    • 1
  • F. de Andrés-Trelles
    • 2
  • F. Catalá-López
    • 1
  1. 1.Division of Pharmacoepidemiology and PharmacovigilanceSpanish Agency for Medicines and Medical Devices (AEMPS)MadridSpain
  2. 2.Pharmacology Department, School of MedicineComplutense University of MadridMadridSpain

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