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Changing predictors of statin initiation in US women over two decades
Author(s) -
Kinsey Tracy L.,
Stürmer Til,
Poole Charles,
Rothman Kenneth J.,
Glynn Robert J.
Publication year - 2019
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4704
Subject(s) - medicine , confidence interval , statin , diabetes mellitus , cholesterol , pharmacoepidemiology , national cholesterol education program , cohort , cohort study , cardiology , endocrinology , medical prescription , metabolic syndrome , pharmacology
Purpose To describe changing roles of predictors of statin initiation before and after incident coronary heart disease, and before and after publication of National Cholesterol Education Program Adult Treatment Panel‐III (ATP‐III) guidelines in a cohort of US women. Methods We identified 34 382 women enrolled into the Women's Health Study from 1993 to 1995 and followed up until 2012. Proportions of previous nonusers initiating statins were described over time. We used multivariable linear regression models to estimate adjusted initiation proportion differences (IPDs) for initiation overall, separately before and after incident coronary heart disease, and separately for ATP‐II and ATP‐III time periods. Results Key predictors of initiation overall were self‐reported total cholesterol, and previous incident coronary heart disease, cerebrovascular disease, and diabetes. Adjusted IPDs (percentage) for total cholesterol > 240 vs <200 mg/dL were 7.5 (95% confidence interval [CI], 7.0‐8.0) and 9.3 (95% CI, 8.7‐9.9) during ATP‐II and ATP‐III time periods, respectively. Adjusted IPDs in women with diabetes were 7.0 (95% CI, 6.3‐7.8) and 11.9 (95% CI, 6.7‐17.0) for primary and secondary prevention, respectively, and 3.1 (95% CI, 2.1‐4.0) and 9.2 (95% CI 8.2‐10.2) for before and after ATP‐III, respectively. Conclusions Secular trends reflected evolution toward risk factor‐based treatment indications for statin initiation with increased initiation among diabetics and women with normal and borderline cholesterol. The role of serum cholesterol changed over time, though the character was scale (multiplicative vs additive) dependent. In pharmacoepidemiologic studies of statins, strength of confounding by important variables sometimes unmeasured in claims data, such as cholesterol level, may be calendar time dependent.