Skip to main content
Log in

Adherence to statin therapy and patients’ cardiovascular risk: a pharmacoepidemiological study in Italy

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Aim

To evaluate the pattern of use of statins in the Emilia Romagna Region, with a focus on the therapeutic regimens and the patient’s risk profile as predictors of adherence to therapy.

Methods All patients from Emilia Romagna (4,027,275 inhabitants) receiving statin prescriptions in Janurary–February 2005 were selected and observed for 12 months in terms of their statin regimen and use of other drugs for cardiovascular risk prevention. Previous hospital admissions for major cardiovascular events were also obtained. Adherence to statins was evaluated in terms of coverage (covered: ≥300 tablets/year). The relationship between coverage and risk profile (age, sex, other cardiovascular drugs, previous cardiovascular events and choice of drugs/dosages) was analysed by multivariate logistic regression.

Results Among the 137,217 patients receiving at least one prescription in the observation period, the rate of coverage was 46%. Coverage was statistically higher in patients with a previous hospital admission (secondary prevention) [Odds ratio (OR) 1.19; 95% confidence interval (95% CI) 1.16, 1.22], in those concomitantly treated with three to four different cardiovascular drugs (OR 2.77; 95% CI 2.66, 2.89). The coverage was also statistically higher in patients aged 50–69 years (OR 1.14; 95% CI 1.08, 1.20) and among males (OR 1.21; 95% CI 1.18, 1.23).

Conclusions Less than half of patients receiving statin therapy took their medication daily, with a coverage only slightly higher in patients at higher cardiovascular risk. Three-quarters of the patients received statin therapy in primary prevention, whereas the benefits of statins are documented mostly for patients in secondary prevention. These findings strengthen the need to sensitise physicians and patients to the correct use of statins.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Reference

  1. LaRosa JC, Suma V (1999) Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 282:2340–2346

    Article  PubMed  CAS  Google Scholar 

  2. Baigent C, Keech A, Kearney PM 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 366:1267–1278

    Article  PubMed  CAS  Google Scholar 

  3. Abramson J, Wright JM (2007) Are lipid-lowering guidelines evidence-based? Lancet 369:168–169

    Article  PubMed  CAS  Google Scholar 

  4. McElduff P, Jaefarnezhad M, Durrington PN (2006) American, British and European recommendations for statins in the primary prevention of cardiovascular disease applied to British men studied prospectively. Heart 92:1213–1218

    Article  PubMed  CAS  Google Scholar 

  5. Penning-van Beest FJ, Termorshuizen F, Goettsch WG, Klungel OH, Kastelein JJ, Herings RM (2007) Adherence to evidence-based statin guidelines reduces the risk of hospitalizations for acute myocardial infarction by 40%: a cohort study. Eur Heart J 28:154–159

    Article  PubMed  CAS  Google Scholar 

  6. Poluzzi E, Strahinja P, Vargiu A et al (2005) Initial treatment of hypertension and adherence to therapy in general practice in Italy. Eur J Clin Pharmacol 61:603–609

    Article  PubMed  CAS  Google Scholar 

  7. Poluzzi E, Strahinja P, Vaccheri A et al (2007) Adherence to chronic cardiovascular therapies: persistence over the years and dose coverage. Br J Clin Pharmacol 63:346–355

    Article  PubMed  CAS  Google Scholar 

  8. Walley T, Folino-Gallo P, Stephens 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 60:543–551

    Article  PubMed  CAS  Google Scholar 

  9. Caro JJ, Speckman JL, Salas M, Raggio G, Jackson JD (1999) Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data. Can Med Assoc J 160:41–46

    CAS  Google Scholar 

  10. Valuck RJ, Williams SA, MacArthur M et al (2003) A retrospective cohort study of correlates of response to pharmacologic therapy for hyperlipidemia in members of a managed care organization. Clin Ther 25:2936–2957

    Article  PubMed  Google Scholar 

  11. Benner JS, Pollack MF, Smith TW, Bullano MF, Willey VJ, Williams SA (2005) Association between short-term effectiveness of statins and long-term adherence to lipid-lowering therapy. Am J Health Syst Pharm 62:1468–1475

    Article  PubMed  CAS  Google Scholar 

  12. Brookhart MA, Patrick AR, Schneeweiss S et al (2007) Physician follow-up and provider continuity are associated with long-term medication adherence: a study of the dynamics of statin use. Arch Intern Med 167:847–852

    Article  PubMed  Google Scholar 

  13. Larsen J, Vaccheri A, Andersen M, Montanaro N, Bergman U (2000) Lack of adherence to lipid-lowering drug treatment. A comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy. Br J Clin Pharmacol 49:463–471

    Article  PubMed  CAS  Google Scholar 

  14. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J, III (1961) Factors of risk in the development of coronary heart disease-six year follow-up experience. The Framingham Study. Ann Intern Med 55:33–50

    PubMed  CAS  Google Scholar 

  15. Giampaoli S, Palmieri L, Chiodini P et al (2004) The global cardiovascular risk chart. Ital Heart J Suppl 5:177–185

    PubMed  Google Scholar 

  16. Larsen J, Andersen M, Kragstrup J, Gram LF (2002) High persistence of statin use in a Danish population: compliance study 1993–1998. Br J Clin Pharmacol 53:375–378

    Article  PubMed  Google Scholar 

  17. Mant A, Lowinger J, Hall W, Whicker S, Ringland C, Stark H (2007) Statins down under. Br J Clin Pharmacol 63:125–127

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by grants from the Emilia Romagna Region and the University of Bologna.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicola Montanaro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Poluzzi, E., Strahinja, P., Lanzoni, M. et al. Adherence to statin therapy and patients’ cardiovascular risk: a pharmacoepidemiological study in Italy. Eur J Clin Pharmacol 64, 425–432 (2008). https://doi.org/10.1007/s00228-007-0428-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-007-0428-8

Keywords

Navigation