ArticleBMC public health2012
Is the high-risk strategy to prevent cardiovascular disease equitable? A pharmacoepidemiological cohort study.
Article in BMC public health, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 17 citations in OpenAlex.
- Twenty years on from the introduction of the high risk strategy for stroke and cardiovascular disease prevention: a systematic scoping review.European journal of neurology · 2024Article
- Are doctors using more preventive medication for cardiovascular disease? A Swedish cross-sectional study.Scandinavian journal of primary health care · 2023Article
- Primary stroke prevention worldwide: translating evidence into action.The Lancet. Public health · 2022Review
- Multiple Socioeconomic Circumstances and Initiation of Cardiovascular Medication among Ageing Employees.International journal of environmental research and public health · 2021Article
- WSO and WHF joint position statement on population-wide prevention strategies.Lancet (London, England) · 2020Article
- Factors Associated with County-Level Variation in the Prescription of Statins.Journal of managed care & specialty pharmacy · 2019Article
- Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: Microsimulation modelling using data from Liverpool, UK.PLoS medicine · 2018Article
- Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options.BMJ (Clinical research ed.) · 2016Article
- Relationship between Statin Utilization and Socioeconomic Deprivation in Hungary.Frontiers in pharmacology · 2016Article
- Using drug sales data to evaluate the epidemiology of cardiometabolic risk factors and their inequality: an ecological study on atorvastatin and total cholesterol in Iran.Medical journal of the Islamic Republic of Iran · 2015Article
- Adherence to preventive statin therapy according to socioeconomic position.European journal of clinical pharmacology · 2013Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStatins are increasingly prescribed to prevent cardiovascular disease (CVD) in asymptomatic individuals. Yet, it is unknown whether those at higher CVD risk - i.e. individuals in lower socio-economic position (SEP) - are adequately reached by this high-risk strategy. We aimed to examine whether the Danish implementation of the strategy to prevent cardiovascular disease (CVD) by initiating statin (HMG-CoA reductase inhibitor) therapy in high-risk individuals is equitable across socioeconomic groups.
methods
designCohort study. SETTING AND
participantsApplying individual-level nationwide register information on socio-demographics, dispensed prescription drugs and hospital discharges, all Danish citizens aged 20+ without previous register-markers of CVD, diabetes or statin therapy were followed during 2002-2006 for first occurrence of myocardial infarction (MI) and a dispensed statin prescription (N = 3.3 mill).
main outcome measuresStratified by gender, 5-year age-groups and socioeconomic position (SEP), incidence of MI was applied as a proxy for statin need. Need-standardized statin incidence rates were calculated, applying MI incidence rate ratios (IRR) as need-weights to adjust for unequal needs across SEP.Horizontal equity in initiating statin therapy was tested by means of Poisson regression analysis. Applying the need-standardized statin parameters and the lowest SEP-group as reference, a need-standardized statin IRR > 1 translates into horizontal inequity favouring the higher SEP-groups.
resultsMI incidence decreased with increasing SEP without a parallel trend in incidence of statin therapy. According to the regression analyses, the need-standardized statin incidence increased in men aged 40-64 by 17%, IRR 1.17 (95% CI: 1.14-1.19) with each increase in income quintile. In women the proportion was 23%, IRR 1.23 (1.16-1.29). An analogous pattern was seen applying education as SEP indicator and among subjects aged 65-84.
conclusionThe high-risk strategy to prevent CVD by initiating statin therapy seems to be inequitable, reaching primarily high-risk subjects in lower risk SEP-groups.
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