Determination of non-treatment with statins of high risk patients in the Netherlands

Abstract

Objective:

To determine in the Netherlands what proportions of high risk patients with established cardiovascular disease (CVD) or diabetes mellitus type 2 (DM2) who were not treated with statins on 1 January 2007 and which characteristics were associated with non-treatment.

Methods:

From the IPCI GP database patients were selected who were registered with a GP on 1 January 2007 who had a history of either CVD (CVD patients), DM2 (diabetics) or both (diabetics with CVD). The proportion of patients using statins around 1 January 2007 was determined. Associations of patient characteristics with non-treatment were quantified (CVD patients and diabetics only).

Results:

In all, 19 628 CVD patients, 5006 diabetics and 3767 diabetics with CVD were identified. Of these patients 71%, 54% and 45%, respectively did not use statins. These proportions were similar in the subgroups of patients with recent LDL-C measurements. Among these subgroups the vast majority of non-treated patients was eligible for statin treatment (LDL-C >2.5 mmol/l). The proportion of statin-treated patients was larger among diabetics than among CVD patients. Among CVD patients, female gender, age below 40 years, living in a deprived area, a history of CVD of less than 1 year and arrhythmia were significantly associated with non-treatment. Among diabetics, significant associations were: living in a deprived area and specialist visits in the previous year. In 2003, treatment rates among diabetics were lower, but among CVD patients they were similar. This suggests that the higher treatment rates among diabetics compared to CVD patients in 2007 may be the result of disease-management programmes introduced for diabetics in 2004.

Conclusion:

The majority of patients with established CVD or DM2 were not treated with statins on 1 January 2007. Eligibility for statin treatment may have been overestimated due to unavailability of cholesterol levels among many non-treated patients. Implementation of care programmes for CVD patients may increase treatment rates among eligible CVD patients.

Key words::

• Cardiovascular disease
• Diabetes
• Observational study
• Statins

Transparency

Declaration of funding

Pfizer BV funded the study perormed by the PHARMO Institute and the article was written by employees of the PHARMO Institute. The sponsor was involved in conception and design of the study, in the interpretation of the results and in critical revision of the manuscript. The researchers from the PHARMO Institute and M.S. were scientifically independent from the funders.

Declaration of financial/other relationships

The PHARMO Institute is a research institute that performs financially supported studies for several pharmaceutical companies, including AstraZeneca, Pfizer, Merck Sharp & Dohme and Novartis. P.H., A.P. and E.H. are employees of the PHARMO Institute but have disclosed that they have no financial or other relationship with any commercial companies related to this study or article or other relevant financial interests in general. R.H. is an employee of the PHARMO Institute and has delivered lectures for several pharmaceutical companies, including Pfizer, AstraZeneca, Merck Sharp & Dohme, Novartis and several generic pharmaceutical companies. W.J.M. and K.W. are employees of and own stock in Pfizer. M.S. coordinates a research group and has disclosed that she has received various unrestricted grants from pharmaceutical companies including Eli Lilly, Pfizer, Merck, Roche, GSK and AstraZeneca; she has also acted as a consultant to Pfizer, Novartis and Lundbeck.

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she has no relevant financial interests; Peer Reviewer 2 has disclosed that he/she is recipient of sponsorship funding to attend meetings on behalf of Merck, Sharpe & Dohme (MSD) and AstraZeneca; is a consultant for MSD; and is a member of the speakers bureaux for MSD, Solvay and AstraZeneca.

Acknowledgements

The authors like to thank Fernie Penning-van Beest for her support and critical mind.