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Drugs & Aging

, Volume 27, Issue 7, pp 589–596 | Cite as

Statin Prescribing in the Elderly in the Netherlands

A Pharmacy Database Time Trend Study
  • Marjolein Geleedst-De Vooght
  • Anke-Hilse Maitland-van der Zee
  • Tom Schalekamp
  • Aukje Mantel-Teeuwisse
  • Paul Jansen
Original Research Article

Abstract

Introduction There is some evidence that the beneficial effects of HMG-CoA reductase inhibitors (statins) in the elderly are at least comparable to the effects in middle-aged people. However, several studies have shown prescription rates of statins to be significantly lower in the elderly than in younger populations.

Objective The aim of the present study was to monitor statin prescribing trends in the elderly in the Netherlands over time in terms of prevalence, incidence, type of statin, dose prescribed and adherence to clinical guidelines.

Methods The database of a community pharmacy in Utrecht, which includes prescription data for approximately 11 000 people, was analysed to investigate trends in statin prescriptions from January 1999 to December 2008. The 1-year prevalence and incidence of statin use stratified by age were determined for each calendar year. Rate ratios (RRs) and 95% confidence intervals were calculated with 1999 as the reference year. Furthermore, the following trends of interest were calculated for each calendar year: the percentage of statin users prescribed simvastatin or atorvastatin, the median dose of simvastatin and atorvastatin prescribed, and the percentage of simvastatin users prescribed a dosage of 40 mg/day (which is recommended by the Dutch multidisciplinary guideline).

Results The 1-year prevalence of statin use in medication users aged ≥50 years increased from 13.9% in 1999 to 22.8% in 2008 (RR 1.6; 95% CI 1.4, 1.9; p<0.001). Overall, the lowest prevalence (5.1% in 1999 and 15.2% in 2008) and incidence rates (3.2% in 2000 and 4.2% in 2008) were found in patients aged ≥80 years. Before 2006, simvastatin was the most commonly prescribed statin, but the number of users declined as the percentage of patients with new simvastatin prescriptions decreased (from 43.4% in 2000 to 36.5% in 2005) and the percentage of patients treated with new atorvastatin prescriptions increased (from 37.7% in 2000 to 47.3% in 2005). As from 2006, when the Dutch multidisciplinary guideline for Cardiovascular Risk Management was introduced, recommending treatment with a daily simvastatin dose of 40 mg, the number of simvastatin users increased again and most treatment-naive patients were started on simvastatin (62.3% in 2006, increasing to 66.7% in 2008). The median simvastatin dose increased from 10 mg in 1999 to 20 mg in 2001, remaining at the same dose until 2008, and appeared to be related to the patient’s age. From 2006, patients aged ≥80 years were the least likely group to receive the recommended dose of 40 mg simvastatin daily (10.0–20.0% of simvastatin users aged ≥80 years compared with 32.5–36.9% of simvastatin users aged 60–69 years).

Conclusion Despite the benefits of statin treatment previously reported in older patients, the prevalence and incidence of statin use were lower in elderly patients compared with younger patients. In addition, lower dosages of statins were prescribed. These findings suggest the beneficial effects of statins in the elderly observed in clinical trials may not be achieved in everyday practice.

Keywords

Statin Simvastatin Atorvastatin Pravastatin Statin Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

No sources of funding were used to assist in the conduct of this investigator-initiated study. The division of Pharmacoepidemiology & Pharmacotherapy that employs AM-Z, AM-T and TS has received unrestricted funding for pharmacoepidemiological research from GlaxoSmithKline, Novo Nordisk, the privately/publicly funded Top Institute Pharma (www.tipharma.nl) [includes co-funding from universities, government and industry], the Dutch Medicines Evaluation Board and the Dutch Ministry of Health.

The authors have no conflicts of interest that are directly relevant to the content of this study.

References

  1. 1.
    Costa J, Borges M, David C, et al. Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: meta-analysis of randomised controlled trials. BMJ 2006; 332(7550): 1115–24PubMedCrossRefGoogle Scholar
  2. 2.
    Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Lancet 2005; 366(9493): 1267–78PubMedCrossRefGoogle Scholar
  3. 3.
    Pyörälä K, De Backer G, Graham I, et al. Prevention of coronary heart disease in clinical practice: recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J 1994; 15(10): 1300–31PubMedGoogle Scholar
  4. 4.
    Wood D, De Backer G, Faergeman O, et al. Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. Eur Heart J 1998; 19(10): 1434–503CrossRefGoogle Scholar
  5. 5.
    De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2003; 24(17): 1601–10PubMedCrossRefGoogle Scholar
  6. 6.
    Thomas S, Van der Weijden T, Van Drenth BB, et al. NHG standard cholesterol [in Dutch]. Huisarts Wet 1999; 42(9): 406–17Google Scholar
  7. 7.
    CBO, Kwaliteitsinstituut voor de Gezondheidszorg. Guideline cholesterol [in Dutch]. Utrecht: CBO, 1998Google Scholar
  8. 8.
    Smulders YM, Burgers JS, Scheltens T, et al. Clinical practice guideline for cardiovascular risk management in the Netherlands. Neth J Med 2008; 66(4): 169–74PubMedGoogle Scholar
  9. 9.
    Walley T, Folino-Gallo P, Stephens P, et al. Trends in prescribing and utilization of statins and other lipid lowering drugs across Europe 1997–2003. Br J Clin Pharmacol 2005; 60(5): 543–51PubMedCrossRefGoogle Scholar
  10. 10.
    Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo controlled trial. Lancet 2002; 360(9326): 7–22CrossRefGoogle Scholar
  11. 11.
    Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360: 1623–30PubMedCrossRefGoogle Scholar
  12. 12.
    Wenger NK, Lewis SJ, Herrington DM, et al. Outcomes of using high- or low-dose atorvastatin in patients 65 years of age or older with stable coronary heart disease. Ann Intern Med 2007; 147(1): 1–9PubMedGoogle Scholar
  13. 13.
    Olsson AG, Schwartz GG, Szarek M, et al. Effects of high-dose atorvastatin in patients > or=65 years of age with acute coronary syndrome (from the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study). Am J Cardiol 2007; 99(5): 632–5PubMedCrossRefGoogle Scholar
  14. 14.
    Neil HA, DeMicco DA, Luo D, et al. Analysis of efficacy and safety in patients aged 65–75 years at randomisation: Collaborative Atorvastatin Diabetes Study (CARDS). Diabetes Care 2006; 29(11): 2378–84PubMedCrossRefGoogle Scholar
  15. 15.
    Rinfret S, Behlouli H, Eisenberg MJ, et al. Class effects of statins in elderly patients with congestive heart failure: a population-based analysis. Am Heart J 2008; 155(2): 316–23PubMedCrossRefGoogle Scholar
  16. 16.
    Hunt D, Young P, Simes J, et al. 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 2001; 134(10): 931–40PubMedGoogle Scholar
  17. 17.
    Afilalo J, Dugue G, Steele R, et al. Statins for secondary prevention in elderly patients: a hierarchical Bayesian meta-analyses. J Am Coll Cardiol 2008; 51(1): 37–45PubMedCrossRefGoogle Scholar
  18. 18.
    Tikkanen MJ, Holme I, Cater NB, et al. Comparison of efficacy and safety of atorvastatin (80 mg) to simvastatin (20–40 mg) in patients aged <65 versus ≥65 years with coronary heart disease (from the Incremental DEcrease through Aggressive Lipid Lowering [IDEAL] study). Am J Cardiol 2009; 103: 577–82PubMedCrossRefGoogle Scholar
  19. 19.
    Teeling M, Bennett K, Feely J. The influence of guidelines on the use of statins: analysis of prescribing trends 1998–2002. Br J Clin Pharmacol 2005; 59(2): 227–32PubMedCrossRefGoogle Scholar
  20. 20.
    Williams D, Bennett K, Feely J. Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care. Br J Clin Pharmacol 2003; 55(6): 604–8PubMedCrossRefGoogle Scholar
  21. 21.
    Ridker PM, Rifai N, Clearfield M, et al. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med 2001; 344(26): 1959–65PubMedCrossRefGoogle Scholar
  22. 22.
    Lau HS, de Boer A, Beuning KS, et al. Validation of pharmacy records in drug exposure assessment. J Clin Epidemiol 1997; 50(5): 619–25PubMedCrossRefGoogle Scholar
  23. 23.
    WHO Collaborating Centre for Drug Statistics. ATC/DDD Index 2009 [online]. Available from URL: http://www.whocc.no [Accessed 2009 Nov 10]
  24. 24.
    Ray KK, Cannon CP. The potential relevance of the multiple lipid-independent (pleiotropic) effects of statins in the management of acute coronary syndromes. J Am Coll Cardiol 2005; 46: 1425–33PubMedCrossRefGoogle Scholar
  25. 25.
    Ko DT, Mamdani M, Alter DA. Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. JAMA 2004; 291(15): 1864–70PubMedCrossRefGoogle Scholar
  26. 26.
    Centraal Bureau voor de Statistiek, The Hague/Heerlen [online]. Available from URL: http://www.cbs.nl/nl-NL/menu/themas/bevolking/cijfers/default.htm [Accessed 2009 Nov 10]
  27. 27.
    Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 1993; 88: 1973–98PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Marjolein Geleedst-De Vooght
    • 1
  • Anke-Hilse Maitland-van der Zee
    • 2
  • Tom Schalekamp
    • 2
  • Aukje Mantel-Teeuwisse
    • 2
  • Paul Jansen
    • 3
  1. 1.Pharmacy LusseUtrechtthe Netherlands
  2. 2.Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of ScienceUtrecht UniversityUtrechtthe Netherlands
  3. 3.Department of GeriatricsUniversity Medical CentreUtrechtthe Netherlands

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