Trends in secondary prevention of ischaemic heart disease in the UK 1994 2005: use of individual and combination treatment.
BACKGROUND
Statins, antiplatelet drugs, beta-blockers and ACE inhibitors may produce marked benefits in secondary prevention of ischaemic heart disease (IHD), especially in combination.


OBJECTIVE
To examine trends in treatment and factors associated with treatment using a population-based general practice database.


METHODS
Analysis of routinely collected computerised data from 201 general practices using iSOFT software contributing to the DIN-LINK database.


METHODS
Subjects aged >or=35 years and registered with the practices; on average, 30 000 men and 21 000 women with IHD each year.


METHODS
Percentage of subjects with IHD receiving individual drugs and combined treatment in any given year.


RESULTS
Between 1994 and 2005 use of drugs for secondary prevention increased markedly. By 2005, 80% of men and 70% of women were receiving a statin, 75% and 74% were receiving antiplatelet drugs, 55% and 48% were receiving beta-blockers and 57% and 51% were receiving an ACE inhibitor; 55% of men and 46% of women were receiving a statin, antiplatelet drug and either beta-blocker or ACE inhibitor, of whom just under half were receiving all four classes of drug. Gender differences were largely explained by more severe disease in men. In 2005, subjects less likely to receive combination therapy were older, had not had a myocardial infarction or revascularisation, and lacked comorbidities such as diabetes or hypertension.


CONCLUSIONS
Despite high levels of statin and antiplatelet prescribing, opportunities exist for increasing the benefits of secondary prevention, especially through the wider use of combined treatments. Future targets could usefully include combination therapy.
DeWilde
S
S
Division of Community Health Sciences, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
Carey
I M
IM
Richards
N
N
Whincup
P H
PH
Cook
D G
DG
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D005194:Family Practice / Q000639:trends; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011314:Preventive Health Services / Q000639:trends*; D006113:United Kingdom / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004791:Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors