Trends in coronary heart disease mortality and statin utilization in two European areas with different population risk levels: Stockholm and Sicily

Background and Aim: The reduction in coronary heart disease (CHD) mortality in Europe has been associated with a reduction in coronary risk factors, including dyslipidaemia. Statins reduce blood cholesterol levels and the risk of coronary events. Their utilization has substantially increased over the years. Although statins should be prescribed according to clinical guidelines, doctors’ decisions about treatment are usually made subjectively and are influenced by the population risk level. The aim of this study was to investigate the relation between the time trend of population risk level and statin utilization in two areas with different levels of coronary risk in the population. Methods: CHD mortality, as a proxy of population coronary risk level, and statin utilization trends in the period 2001-2011, were compared between a relatively high-risk CHD area, Stockholm county, and a low-risk area, Sicily. Results: There was a reduction in CHD mortality and an increase in statin utilization in both areas. The mean annual reduction in CHD mortality rate/100,000 was greater in Stockholm than in Sicily (-4.6, 95% CI -5.3 -4.0, and -1.9 95% CI -2.6 – 1.2, respectively). The mean annual increase in statin DDD/TID utilization was larger in Sicily than in Stockholm (5.1, 95% CI 4.8 – 5.3, and 3.7, 95% CI 3.2 – 4.1, respectively). In Stockholm the increase in statin use was mainly due to increased utilization of simvastatin, whereas it included a greater variety of statins in Sicily. Conclusion: The relations between time trends of CHD mortality and statin utilization in Stockholm and in Sicily were different. A larger increase in statins was observed in the low-risk area, associated with a slower reduction in CHD mortality, whereas a smaller increase in statins was observed in the high-risk area, associated with a greater reduction in CHD mortality. Other factors apart from the actual risk of the patients may explain these observations, such as differences in socioeconomic factors, adherence to treatment, policies of drug cost-containment, and population CHD risk profiles.