Undertreatment and overtreatment with statins: the Oslo Health Study 2000-2001.
OBJECTIVE
We examined the prevalence and factors associated with use of cholesterol-lowering statins in the population.


METHODS
Demographic, medical, anthropometric and lifestyle data was obtained from 6233 men and 7521 women born in 1924/25, 1940/41, 1955 and 1960 that participated in the Oslo Health Study 2000-2001. A nonfasting blood sample was collected.


RESULTS
Of subjects with a heart attack, angina, stroke or diabetes 45% of men and 35% of women were taking a statin (P < 0.001). Of subjects with cardiovascular disease (CVD) or diabetes taking statins 61% of men and 40% of women achieved total serum cholesterol levels < or =5 mmol L(-1). The odds ratio for taking a statin was increased amongst subjects who also took antihypertensive drug(s) or acetylsalicylic acid, subjects with a family history of coronary heart disease (CHD) and women who had visited the general practitioner within the last year. Amongst presumed healthy subjects use of statins increased from about 1% in women aged 40-45 years, to 7% at age 60 and to 12% at age 75 whilst the corresponding figures for men were 3%, 8% and 9%, respectively. About 22% of men but <2% of women aged 60 who were not taking statins had a 10-year Framingham CHD risk score >20%. Determinants of statin use were similar to those amongst subjects with CVD or diabetes.


CONCLUSIONS
People with CVD or diabetes remain undertreated with statins, women more so than men. Use of other preventive drugs, the family history and recent contact with the general practitioner were the most important determinants of statin use in primary and secondary prevention. Amongst healthy subjects aged 60 or 75 years women received statins disproportionately to their low CHD risk compared with men.
Tonstad
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Department of Preventive Cardiology, Preventive Medicine Clinic, Ullevål University Hospital, Oslo, Norway. serena.todstad@ulleval.no
Rosvold
E O
EO
Furu
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K
Skurtveit
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D000328:Adult; D000367:Age Factors; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D005192:Family Health; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010342:Patient Acceptance of Health Care
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D002784:Cholesterol; D001241:Aspirin