Who receives lipid-lowering drugs: the effects of comorbidities and patient characteristics on treatment initiation.
OBJECTIVE
Little is known about the effects of comorbidities and patient characteristics on treatment initiation of lipid-lowering drugs (LLDs), which can be helpful in the evaluation of the risks and benefits of LLDs.


METHODS
Baseline characteristics among subjects who received their first ever-recorded LLD prescription in general practice between 1 January 1990 and 31 December 1997, and hyperlipidaemic patients without LLD therapy during the same period were obtained from the UK General Practice Research Database. Differences between patients who received and patients who did not receive LLDs, as well as patients who received different classes of LLDs were compared by fitting multivariate logistic regression models that adjusted for age, sex, body mass index, smoking status, and year of treatment initiation or hyperlipidaemia diagnosis.


RESULTS
We found that there were many differences in the baseline characteristics, such as number of general practitioner visits, diagnosis and severity of cardiovascular diseases, and concurrent medications, between the 25 331 patients who received and the 16 287 patients who did not receive LLDs. We also noted that patients with statin therapy had more prior hospitalization, more recent myocardial infarction/stroke, and more concurrent cardiovascular medications, than those patients who received other LLDs.


CONCLUSIONS
Patients who received LLDs in primary care, especially patients with statin therapy, were more likely to be elderly and to have more concomitant severe cardiovascular comorbidities than those hyperlipidaemic patients who did not receive LLDs. Examining the medical records of individuals eligible for LLD therapy is an important first step in selectively targeting who will experience the greatest benefit to risk ratio for the treatment of hyperlipidaemia, and is an important step in avoiding confounding by indication when designing epidemiological studies comparing the risks and benefits of treatments for hyperlipidaemia.
Yang
Chen-Chang
CC
Department of Medicine, School of Medicine, National Yang-Ming University, 155 Li-Nong, Street, Section 2, Taipei, Taiwan 11217.
Jick
Susan S
SS
Testa
Marcia A
MA
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000517:prevention & control; D048909:Diabetes Complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000150:complications; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents