Skip to main content

Advertisement

SpringerLink
Log in

A 10-Year Trend in Statin Use Among Older Adults in Australia: an Analysis Using National Pharmacy Claims Data

  • ORIGINAL ARTICLE
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Background

Statins have become standard of care in the prevention and treatment of atherosclerotic cardiovascular disease. The objective of this study was to examine the trends in statin use among Australians aged ≥ 65 years for the period 2007–2016.

Methods

Data from the Pharmaceutical Benefits Scheme covering a 10% random sample of the Australian population were analysed. The 1-year prevalence and incidence of statin use were determined for each year, as were the percentage of statin dispensations according to statin type or intensity and the percentage of new users prescribed each statin type or intensity. To describe relative changes, age-sex adjusted rate ratios (RRs) and 95% confidence intervals (CIs) were determined via Poisson regression modelling using 2007 as the reference year.

Results

The 1-year prevalence of statin use increased consistently each year from 34.2% in 2007 to 44.1% in 2016 (RR 1.29, 95% CI 1.28–1.31). The 1-year incidence was 68.5 per 1000 in 2007 and 59.0 per 1000 in 2016 (RR 0.87, 95% CI 0.84–0.90). Women were 18% (age-adjusted rate ratio [aRR] 0.82, 95% CI 0.79–0.83) less likely than men to initiate statins across all years. The incidence of statin use was also highest among individuals aged 65–74 years, who were about 15% (sex-adjusted rate ratio [sRR] 1.15, 95% CI 1.13–1.16) and 45% (sRR 1.45, 95% CI 1.44–1.47) more likely to initiate statins than those aged 75–84 and ≥ 85 years, respectively. Atorvastatin was the most commonly dispensed statin across all years. The proportion of new users dispensed high-intensity statins increased year-on-year from 23.6% in 2007 to 30.5% in 2016 (RR 1.26, 95% CI 1.21–1.31).

Conclusion

The proportion of older adults in Australia using statins has increased over the last decade, although the incidence has declined. Atorvastatin is the most commonly dispensed statin and the use of high intensity statin has increased.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ofori-Asenso R, Zomer E, Curtis A, Zoungas S, Gambhir M. Measures of population ageing in Australia from 1950 to 2050. J Popul Ageing. 2017:1–19.

  2. Jin K, Simpkins JW, Ji X, Leis M, Stambler I. The critical need to promote research of aging and aging-related diseases to improve health and longevity of the elderly population. Aging Dis. 2015;6:1–5.

    Article  PubMed  Google Scholar 

  3. Naci H, Brugts JJ, Fleurence R, Tsoi B, Toor H, Ades AE. Comparative benefits of statins in the primary and secondary prevention of major coronary events and all-cause mortality: a network meta-analysis of placebo-controlled and active-comparator trials. Eur J Prev Cardiol. 2013;20:641–57.

    Article  PubMed  Google Scholar 

  4. Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016;388:2532–61.

    Article  PubMed  CAS  Google Scholar 

  5. Abramson JD, Rosenberg HG, Jewell N, Wright JM. Should people at low risk of cardiovascular disease take a statin? BMJ. 2013;347:f6123.

    Article  PubMed  Google Scholar 

  6. Stone NJ, Intwala S, Katz D. Statins in very elderly adults (debate). J Am Geriatr Soc. 2014;62:943–5.

    Article  PubMed  Google Scholar 

  7. Pedro-Botet J, Climent E, Chillaron JJ, Toro R, Benaiges D, Flores-Le Roux JA. Statins for primary cardiovascular prevention in the elderly. J Geriatr Cardiol. 2015;12:431–8.

    PubMed  PubMed Central  Google Scholar 

  8. Matthews A, Herrett E, Gasparrini A, Van Staa T, Goldacre B, Smeeth L, et al. Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care data. BMJ. 2016;353:i3283.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nielsen SF, Nordestgaard BG. Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study. Eur Heart J. 2016;37:908–16.

    Article  PubMed  Google Scholar 

  10. Schaffer AL, Buckley NA, Dobbins TA, Banks E, Pearson SA. The crux of the matter: did the ABC’s catalyst program change statin use in Australia? Med J Aust. 2015;202:591–5.

    Article  PubMed  Google Scholar 

  11. Choudhry NK, Shrank WH. Four-dollar generics—increased accessibility, impaired quality assurance. N Engl J Med. 2010;363:1885–7.

    Article  PubMed  CAS  Google Scholar 

  12. Mansfield SJ. Generic drug prices and policy in Australia: room for improvement? A comparative analysis with England. Aust Health Rev. 2014;38:6–15.

    Article  PubMed  Google Scholar 

  13. Gnjidic D, Wilson N, March L, Cumming RG, Cameron ID, Hilmer SN. Statin utilisation patterns in older Australians living in residential care: 1-year prevalence study. Intern Med J. 2015;45:106–9.

    Article  PubMed  CAS  Google Scholar 

  14. Warren JR, Falster MO, Fox D, Jorm L. Factors influencing adherence in long-term use of statins. Pharmacoepidemiol Drug Saf. 2013;22:1298–307.

    Article  PubMed  CAS  Google Scholar 

  15. Gadzhanova S, Roughead E, Ilomaki J. Use of statins in an Australian elderly population. Int J Clin Cardiol. 2014;1:1–4.

    Article  Google Scholar 

  16. Department of Health. About the PBS. 2016.

  17. Mellish L, Karanges EA, Litchfield MJ, Schaffer AL, Blanch B, Daniels BJ, et al. The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers. BMC Res Notes. 2015;8:634.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Simons LA, Ortiz M, Calcino G. Long term persistence with statin therapy—experience in Australia 2006–2010. Aust Fam Physician. 2011;40:319–22.

    PubMed  Google Scholar 

  19. Simons LA, Ortiz M, Calcino G. Persistence with antihypertensive medication: Australia-wide experience, 2004–2006. Med J Aust. 2008;188:224–7.

    PubMed  Google Scholar 

  20. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment Oslo; 2016.

  21. Furberg CD, Pitt B. Withdrawal of cerivastatin from the world market. Curr Control Trials Cardiovasc Med. 2001;2:205–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Geleedst-De Vooght M, Maitland-van der Zee AH, Schalekamp T, Mantel-Teeuwisse A, Jansen P. Statin prescribing in the elderly in the Netherlands: a pharmacy database time trend study. Drugs Aging. 2010;27:589–96.

    Article  PubMed  Google Scholar 

  23. Ruokoniemi P, Helin-Salmivaara A, Klaukka T, Neuvonen PJ, Huupponen R. Shift of statin use towards the elderly in 1995–2005: a nation-wide register study in Finland. Br J Clin Pharmacol. 2008;66:405–10.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889–934.

    Article  PubMed  Google Scholar 

  25. AIHW. Australia’s changing age and gender profile. 2016.

  26. Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust. 2012;196:50–3.

    Article  PubMed  Google Scholar 

  27. Salami JA, Warraich H, Valero-Elizondo J, Spatz ES, Desai NR, Rana JS, et al. National trends in statin use and expenditures in the US adult population from 2002 to 2013: insights from the medical expenditure panel survey. JAMA Cardiol. 2017;2:56–65.

    Article  PubMed  Google Scholar 

  28. Narayan SW, Tordoff JM, Nishtala PS. Temporal trends in the utilisation of preventive medicines by older people: a 9-year population-based study. Arch Gerontol Geriatr. 2016;62:103–11.

    Article  PubMed  Google Scholar 

  29. Minard LV, Corkum A, Sketris I, Fisher J, Zhang Y, Saleh A. Trends in statin use in seniors 1999 to 2013: time series analysis. PLoS One. 2016;11:e0158608.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Vancheri F, Backlund L, Strender LE, Godman B, Wettermark B. Time trends in statin utilisation and coronary mortality in Western European countries. BMJ Open. 2016;6:e010500.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hsieh HC, Hsu JC, Lu CY. 10-year trends in statin utilization in Taiwan: a retrospective study using Taiwan’s National Health Insurance Research Database. BMJ Open. 2017;7:e014150.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mortensen MB, Falk E, Schmidt M. Twenty-year nationwide trends in statin utilization and expenditure in Denmark. Circ Cardiovasc Qual Outcomes. 2017;10:e003811.

    Article  PubMed  Google Scholar 

  33. O'Keeffe AG, Nazareth I, Petersen I. Time trends in the prescription of statins for the primary prevention of cardiovascular disease in the United Kingdom: a cohort study using The Health Improvement Network primary care data. Clin Epidemiol. 2016;8:123–32.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hollingworth SA, Ostino R, David MC, Martin JH, Tett SE. Ezetimibe: use, costs, and adverse events in Australia. Cardiovasc Ther. 2017;35:40–6.

    Article  PubMed  Google Scholar 

  35. Kocas C, Abaci O, Kocas BB, Cetinkal G, Arslan S, Yildiz A, et al. The role of media on statin adherence. Int J Cardiol. 2015;201:139.

    Article  PubMed  Google Scholar 

  36. Zhang H, Plutzky J, Shubina M, Turchin A. Drivers of the sex disparity in statin therapy in patients with coronary artery disease: a cohort study. PLoS One. 2016;11:e0155228.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Bhattacharjee S, Findley PA, Sambamoorthi U. Understanding gender differences in statin use among elderly Medicare beneficiaries: an application of decomposition technique. Drugs Aging. 2012;29:971–80.

    Article  PubMed  CAS  Google Scholar 

  38. Miller P. Women and cardiovascular disease: what can health care providers do to reduce the risks? N C Med J. 2016;77:406–9.

    PubMed  Google Scholar 

  39. Vlassoff C. Gender differences in determinants and consequences of health and illness. J Health Popul Nutr. 2007;25:47–61.

    PubMed  PubMed Central  Google Scholar 

  40. Karalis DG, Wild RA, Maki KC, Gaskins R, Jacobson TA, Sponseller CA, et al. Gender differences in side effects and attitudes regarding statin use in the Understanding Statin Use in America and Gaps in Patient Education (USAGE) study. J Clin Lipidol. 2016;10:833–41.

    Article  PubMed  Google Scholar 

  41. Ofori-Asenso R, Jakhu A, Curtis AJ, Zomer E, Gambhir M, Jaana Korhonen M, et al. A systematic review and meta-analysis of the factors associated with nonadherence and discontinuation of statins among people aged >/=65 years. J Gerontol A Biol Sci Med Sci. 2018;

  42. Escobar C, Echarri R, Barrios V. Relative safety profiles of high dose statin regimens. Vasc Health Risk Manag. 2008;4:525–33.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352:1425–35.

    Article  PubMed  CAS  Google Scholar 

  44. Wilmot KA, Khan A, Krishnan S, Eapen DJ, Sperling L. Statins in the elderly: a patient-focused approach. Clin Cardiol. 2015;38:56–61.

    Article  PubMed  Google Scholar 

  45. Cheng H, Rogers JD, Sweany AE, Dobrinska MR, Stein EA, Tate AC, et al. Influence of age and gender on the plasma profiles of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitory activity following multiple doses of lovastatin and simvastatin. Pharm Res. 1992;9:1629–33.

    Article  PubMed  CAS  Google Scholar 

  46. Therapeutic Goods Administration. Risk factors for myopathy and rhabdomyolysis with the statins. 2004.

  47. Ofori-Asenso R, Jahku A, Zomer E, Curtis A, Korhonen M, Nelson M, et al. Adherence and persistence among statin users aged 65 years and over: a systematic review and meta-analysis. 2017.

  48. Ferrajolo C, Arcoraci V, Sullo MG, Rafaniello C, Sportiello L, Ferrara R, et al. Pattern of statin use in southern Italian primary care: can prescription databases be used for monitoring long-term adherence to the treatment? PLoS One. 2014;9:e102146.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. Clarke PM, Fitzgerald EM. Expiry of patent protection on statins: effects on pharmaceutical expenditure in Australia. Med J Aust. 2010;192:633–6.

    PubMed  Google Scholar 

  50. Thai LP, Moss JR, Godman B, Vitry AI. Cost driver analysis of statin expenditure on Australia’s Pharmaceutical Benefits Scheme. Exp Rev Pharmacoecon Outcomes Res. 2016;16:419–33.

    Article  CAS  Google Scholar 

  51. Brown F, Singer A, Katz A, Konrad G. Statin-prescribing trends for primary and secondary prevention of cardiovascular disease. Can Fam Physician. 2017;63:e495–503.

    PubMed  PubMed Central  Google Scholar 

  52. Ma J, Sehgal NL, Ayanian JZ, Stafford RS. National trends in statin use by coronary heart disease risk category. PLoS Med. 2005;2:e123.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Booth JN 3rd, Colantonio LD, Chen L, Rosenson RS, Monda KL, Safford MM, et al. Statin discontinuation, reinitiation, and persistence patterns among Medicare beneficiaries after myocardial infarction: a cohort study. Circ Cardiovasc Qual Outcomes. 2017;10:e003626.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the Australian Government Department of Human Services for the provision of the data.

Funding

RO is supported by a Monash Graduate Scholarship and Monash International Postgraduate Research Scholarship for his doctoral studies. JI is funded by a National Health and Medical Research Council Early Career Fellowship. SZ is funded by a National Health and Medical Research Council Senior Research Fellowship.

Author information

Authors and Affiliations

  1. Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia

    Richard Ofori-Asenso, Ella Zomer & Danny Liew

  2. Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Richard Ofori-Asenso

  3. Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Richard Ofori-Asenso, Andrea J. Curtis & Sophia Zoungas

  4. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia

    Jenni Ilomäki

  5. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Jenni Ilomäki

Authors
  1. Richard Ofori-Asenso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jenni Ilomäki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ella Zomer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea J. Curtis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sophia Zoungas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Danny Liew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Danny Liew.

Ethics declarations

Conflict of Interest

RO declares no that he has no conflict of interest. JI declares that she has no conflict of interest. EZ declares that she has no conflict of interest. AC declares that she has no conflict of interest. SZ reports past participation in advisory boards and/or receiving honoraria from AstraZeneca/Bristol-Myers Squibb Australia; Janssen-Cilag; Merck, Sharp, and Dohme (Australia); Novartis Australia; Novo Nordisk; Sanofi and Servier Laboratories for work unrelated to this study. DL reports past participation in advisory boards and/or receiving honoraria from Abbvie, Astellas, AstraZeneca, Bristol-Myers Squibb, Novartis, Pfizer, Sanofi and Shire for work unrelated to this study.

Ethics Approval

The study received ethics approval from Monash University Human Research Ethics Committee (approval number 5871). No direct human participants were involved. The Australian Government Department of Human Services also approved the analysis plan and the final manuscript.

Electronic Supplementary Material

Supplementary File S1

(DOCX 12.4 kb)

Supplementary File S2

(DOCX 34.4 kb)

Supplementary File S3

(DOCX 32.6 kb)

Supplementary File S4

(DOCX 102 kb)

Supplementary File S5

(DOCX 90.8 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ofori-Asenso, R., Ilomäki, J., Zomer, E. et al. A 10-Year Trend in Statin Use Among Older Adults in Australia: an Analysis Using National Pharmacy Claims Data. Cardiovasc Drugs Ther 32, 265–272 (2018). https://doi.org/10.1007/s10557-018-6794-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10557-018-6794-x

Keywords

Search

Navigation