Statin use in Brazil: findings and implications

Abstract

Introduction and objectives: Statins have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use.

Methods: Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan. Patients over 18 years old were interviewed from July 2014 to May 2015. The prevalences of statin use and self-reported statin adherence were determined amongst medicine users. The associations between statin use and sociodemographic/health condition variables were assessed using logistic regression.

Results: A total of 8803 patients were interviewed, of whom 6511 were medicine users. The prevalence of statin use was 9.4% with simvastatin (90.3%), atorvastatin (4.7%) and rosuvastatin (1.9%) being the most used statins. Poor adherence was described by 6.5% of patients. Statin use was significantly associated with age ≥65 years old, higher educational level, residence in the South, metabolic and heart diseases, alcohol consumption and polypharmacy.

Conclusions: This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.

Keywords:

• Cardiovascular diseases
• hypercholesterolemia
• statins
• pharmaceutical services
• primary healthcare
• drug utilization
• Brazil

Notes

Transparency

Declaration of funding

This study was funded by the Department for Pharmaceutical Services and Strategic Health Supplies and the Department of Science and Technology of the Secretariat of Science, Technology and Strategic Supplies of the Brazilian Ministry of Health (SCTIE/MS – Process 25000.111834/2, Decentralization of FNS Resources).

Author contributions: R.C.R.M.N.: concept and design, data analysis and interpretation, and the manuscript draft. I.C.G.: data analysis, interpretation and manuscript draft. J.A., F.A.A. and A.A.G. Jr.: concept and design, data review and interpretation, and manuscript draft review. B.G., M.B. and A.B.K.: critical involvement and review of the manuscript, discussion of successive drafts. All authors approved the final version and agreed to be accountable for all aspects of the work.

Declaration of financial/other relationships

R.C.R.M.N., A.A.G. Jr., J.A., I.C.G., B.G., M.B., A.B.K. and F.A.A. have disclosed that they have no conflict of interest.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

There was no assistance in the preparation of this paper.

Notes

1 The Popular Pharmacy Program is a partnership between the Brazilian Ministry of Health and the private pharmaceutical retail sector. In addition to the free-of-charge medicines for hypertension, diabetes and asthma, under the “Saúde não tem preço” (“Health is priceless”) strategy, the program provides statins for dyslipidemia with the Ministry of Health funding 90% of the medicine’s price and the patient 10%.