Cardiovascular Diseases, Cholesterol, LDL, Cross-Sectional Studies, Diabetes Mellitus, Female, Guideline Adherence, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypercholesterolemia, Ireland, Longitudinal Studies, Male, Middle Aged, Practice Guidelines as Topic, Risk Assessment, Risk Factors, Secondary Prevention
Irish Health Research Board Interdisciplinary Capacity Enhancement Award [grant number: ICE/2012/7]. TILDA is funded by the Irish Government (Department of Health), Atlantic Philanthropies and Irish Life.
OBJECTIVES: This study aims to examine the extent to which statins are used by adults at high risk of cardiovascular disease (CVD) compared to European clinical guidelines. The high-risk groups examined are those with (1) known CVD, (2) known diabetes and (3) a high or very high risk (≥5%) of CVD mortality based on Systematic COronary Risk Evaluation (SCORE).
DESIGN: This study is cross-sectional in design using data from the first wave (2009-2011) of The Irish Longitudinal Study on Ageing (TILDA).
SETTING AND PARTICIPANTS: The sample (n=3372) is representative of community living adults aged 50-64 years in Ireland.
RESULTS: Statins were used by 68.6% (95% CI 61.5% to 75.8%) of those with known CVD, 57.4% (95% CI 49.1% to 65.7%) of those with known diabetes and by 19.7% (95% CI 13.0% to 26.3%) of adults with a SCORE risk ≥5%. Over a third (38.5%, 95% CI 31.0% to 46.0%) of those with known CVD, 46.8% (95% CI 38.4% to 55.1%) of those with known diabetes and 85.2% (95% CI 79.3% to 91.1%) of those with a SCORE risk ≥5% were at or above the low-density lipoprotein cholesterol (LDL-C) target of 2.5 mmol/L specified in the 2007 European guidelines.
CONCLUSIONS: Despite strong evidence and clinical guidelines recommending the use of statins for secondary prevention, a gap exists between guidelines and practice in this cohort. It is also of concern that a low proportion of adults with a SCORE risk ≥5% were taking statins. A policy response that strengthens secondary prevention, and improves risk assessment and shared decision-making in the primary prevention of CVD is required.
Medicine and Health Sciences
Murphy C, Bennett K, Fahey T, Shelley E, Graham I, Kenny RA. Statin use in adults at high risk of cardiovascular disease mortality: cross-sectional analysis of baseline data from The Irish Longitudinal Study on Ageing (TILDA). BMJ Open. 2015;5(7):e008017.
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