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Cross-sectional analysis of the prevalence and predictors of statin utilisation in Ireland with a focus on primary prevention of cardiovascular disease
  1. Paula Byrne1,
  2. John Cullinan1,
  3. Catríona Murphy2,3,
  4. Susan M Smith4
  1. 1 National University of Ireland Galway, Galway, Ireland
  2. 2 Dublin City University, Dublin, Ireland
  3. 3 The Irish Longitudinal Study on Ageing (TILDA), Dublin, Ireland
  4. 4 Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Paula Byrne; pbyrne82{at}gmail.com

Abstract

Objective To describe the prevalence of statin utilisation by people aged over 50 years in Ireland and the factors associated with the likelihood of using a statin, focusing particularly on those using statins for primary prevention of cardiovascular disease (CVD).

Methods This is a cross-sectional analysis of cardiovascular risk and sociodemographic factors associated with statin utilisation from wave 1 of The Irish Longitudinal Study on Ageing. A hierarchy of indications for statin utilisation, consisting of eight mutually exclusive levels of CVD-related diagnoses, was created. Participants were assigned one level of indication. The prevalence of statin utilisation was calculated. The likelihood that an individual was using a statin was estimated using a multivariable logistic regression model, controlling for cardiovascular risk and sociodemographic factors.

Results In this nationally representative sample (n=5618) of community-dwelling participants aged 50 years and over, 1715 (30.5%) were taking statins. Of these, 65.0% (57.3% of men and 72.7% of women) were doing so for the primary prevention of CVD. Thus, almost two-thirds of those taking statins did so for primary prevention and there was a notable difference between women and men in this regard. We also found that statin utilisation was highest among those with a prior history of CVD and was significantly associated with age (compared with the base category 50–64 years; 65–74 years OR 1.38 (95% CI 1.16 to 1.65); 75+ OR 1.33 (95% CI 1.04 to 1.69)), living with a spouse or partner (compared with the base category living alone; OR 1.35 (95% CI 1.10 to 1.65)), polypharmacy (OR 1.74 (95% CI 1.39 to 2.19)) and frequency of general practitioner visits (compared with the base category 0 visits per year; 1–2 visits OR 2.46 (95% CI 1.80 to 3.35); 3–4 visits OR 3.24 (95% CI 2.34 to 4.47); 5–6 visits OR 2.98 (95% CI 2.08 to 4.26); 7+ visits OR 2.51 (95% CI 1.73 to 3.63)), even after controlling for clinical need. There was no association between using statins and gender, education, income, social class, health insurance status, location or Systematic Coronary Risk Evaluation (SCORE) risk in the multivariable analysis.

Conclusion Statin utilisation among those with no history of CVD accounted for almost two-thirds of all statin use, in part reflecting the high proportion of the population with no history of CVD, although utilisation rates were highest among those with a history of CVD.

  • cardiology
  • preventive medicine
  • primary care
  • public health
  • therapeutics

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors PB was the lead researcher and involved in the design, implementation and analysis and reporting of the study. JC, CM and SMS provided substantial contributions to the conception, design, analysis and reporting of the work. PB, JC, CM and SMS have all read and approved the final manuscript and agree to be accountable for all aspects of the work.

  • Funding This study is part of PB’s PhD, which is funded by the SPHeRE HRB structured PhD programme. TILDA, the original study on which this is based, is funded by the Irish Department of Health, Irish Life and Atlantic Philanthropies. CM reports grants from the Health Research Board during the conduct of the study (grant no. HRB/ICE 2012/7).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval for the TILDA study was received from the Trinity College Research Ethics Committee and all participants provided written informed consent. TILDA has both publicly available data, which can be accessed as described in the section ’Data sharing', as well as additional data that are available only for research purposes. These data can be accessed on application to and approval by TILDA, which was granted to PB for the purposes of this paper.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Researchers interested in using TILDA data may access the data for free from the following sites: Irish Social Science Data Archive (ISSDA) at University College Dublin http://www.ucd.ie/issda/data/tilda/; Interuniversity Consortium for Political and Social Research (ICPSR) at the University of Michigan: http://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/34315

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