Ezetimibe is used as a second-line lipid-lowering medication (LLM) if statin therapy is not tolerated or cholesterol targets are not reached by statins alone. We aimed to investigate the impact of sociodemographic factors on ezetimibe initiation as (a) incident LLM therapy, (b) add-on therapy, and (c) switch from statins.
All individuals aged 30+ who had filled at least one prescription for either statins (N = 581.074) or ezetimibe (N = 7.932) in 2011 were followed in the nationwide Danish registries to explore LLM prescribing patterns from 1 January 2011 to end 2012. Using logistic regression analyses, the odds ratio (OR) with 95 % confidence intervals (CIs) was calculated for (a) incident ezetimibe use among LLM initiators (N = 77,472), (b) ezetimibe switching by discontinuing statin users (N = 37,509), and (c) ezetimibe as add-on by non-discontinuing statin users (N = 442,672).
Women had higher odds for initiating ezetimibe than men (switch OR = 1.55; 95 % CI = 1.32–1.82). While prior use of newer high-potency statins was the strongest predictor (add-on (5.56; 4.95–6.24), income was the strongest socioeconomic predictor for incident LLM use (1.33; 1.14–1.56) and switching (1.64; 1.27–2.13). Both income and education were predictors for add-on therapy, with the educational effect mediated by prior use of high-potency statins. Odds for ezetimibe prescribing were highest in myocardial infarction patients.
While higher income is a predictor for switching to ezetimibe, both higher education and income are weak predictors for using ezetimibe as add-on therapy. Women and individuals with myocardial infarction are more likely to be prescribed ezetimibe than others, despite lack of evidence of ezetimibe lowering the risk of cardiovascular events.
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The authors wish to acknowledge Theis Lange, associate professor, Section of Biostatistics, University of Copenhagen, for our fruitful discussions about the mediation analyses.
Approval of data access
Access to data was provided and secured through collaboration between the University of Copenhagen and Statistics Denmark. Approval was obtained from the Danish Data Protection Agency through Statistics Denmark. No person identifiers were provided to the researchers. According to Danish law, purely registry-based studies do not require ethical approval .
Conflict of interest
EHH has received an unrestricted grant from MSD, the market authorization holder of Ezetrol (ezetimibe) in Denmark. Both authors declare that they have no conflicts of interest regarding the content of the present study.
EHH had the idea for the study, which was modified during the literature review. Both authors discussed the study design. HWK carried out the literature review, analyzed, and drafted the article. EHH revised the manuscript, and both authors read and agreed on the final version.
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Wallach-Kildemoes, H., Hansen, E.H. Sociodemographic and diagnostic characteristics of prescribing a second-line lipid-lowering medication: ezetimibe used as initial medication, switch from statins, or add-on medication. Eur J Clin Pharmacol 71, 1245–1254 (2015). https://doi.org/10.1007/s00228-015-1907-y
- Lipid-lowering medication
- Second-line treatment