The Pharmaceutical Journal
Vol 268 No 7203 p861-867
22 June 2002

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Inequalities in statin prescribing for both the elderly and smokers identified

Patients who are eligible for treatment with statins are less likely to receive lipid-lowering therapy if they are elderly, have angina but no previous heart attack, or are smokers, according to researchers from St George's Hospital medical school, London.

Dr Fiona Reid and colleagues from the department of public health sciences say that there are inequalities in the prescribing of lipid lowering drugs for people with coronary heart disease and add that this finding comes against a background of low levels of prescribing of these drugs overall.

The researchers analysed prescribing data from the Health Survey for England 1998 and found that only 19.9 per cent of patients with coronary heart disease were receiving lipid-lowering drugs. The likelihood of being treated with statins was reduced for older age groups, with subjects aged 65–74 years being half as likely to receive lipid-lowering treatment as those aged under 65 years. A nine-fold difference was seen for those aged over 75 years.

The researchers argue that the differences in prescribing rates seem unwarranted given that there is no evidence to suggest efficacy of statins decreases with age.

They also found that smokers were less likely to be treated with lipid-lowering drugs and point out that trials have shown statins to be equally effective in smokers and non-smokers. "There seems little justification for withholding a proven pharmacological intervention from this group," they add.

The influence of social class on treatment inequalities was unclear, say the researchers. They found that people living in rented accommodation seemed to be at a possible disadvantage, but that other variables indicative of social status showed less of a link with lipid-lowering treatment.

"It is to be hoped that ... enough evidence has been gathered to convince clinicians in both primary and secondary care that statins should be prescribed for the vast majority of (if not all) patients with coronary heart disease, without regard to age, sex, social class, smoking status, nature of coronary heart disease, or time since diagnosis," they conclude (Heart 2002;88:15).