title: Statin use after first myocardial infarction in UK men and women from 1997 to 2006: Who started and who continued treatment?
abstract: OBJECTIVE
  To examine trends in initiation and continuation of statin treatment after myocardial infarction (MI) and their determinants, during a period of increasing usage.
  
  
  RESULTS
  9367 patients aged 30-84 with a first Myocardial Infarction (MI) in 1997-2006 were identified in DIN-LINK, an anonymised, UK primary care database. We assessed statin initiation (prescription within 6 months of MI) and continued therapy (% covered by a prescription on a given day of those prescribed a statin within 6 months). The influences of co-morbidities and socio-economic deprivation (Index of Multiple Deprivation) were examined. Statin initiation increased from 37% for MIs in 1997 to 92% in 2006. Continuation at 1 year remained stable over successive cohorts at approximately 80%, settling to about 76% in patients with 5-10 years follow up. Younger age, affluence, revascularisation in 6 months after MI, and absence of congestive heart failure, predicted higher initiation and continuation; a diagnosis of hypertension or diabetes predicted higher initiation, while smoking was associated with poorer continuation. Men had higher initiation and continued therapy, but these effects were largely explained by their younger age. Type of statin initially prescribed did not influence continued usage.
  
  
  CONCLUSIONS
  Statin use after MI increased markedly between 1997 and 2006, whilst continued therapy remained high and stable. Importantly, first choice of statin had no effect on continuation. Whilst the high current levels of initiation may have reached a ceiling, increasing continuation rates among smokers, older patients and those from lower socio-economic groups, should remain a priority.
authors.affiliation: Division of Population Health Sciences and Education, St George's University of London, London SW17 0RE, United Kingdom.
authors.forename: I M
authors.initials: IM
authors.lastname: Carey
authors.forename: S
authors.initials: S
authors.lastname: DeWilde
authors.forename: S M
authors.initials: SM
authors.lastname: Shah
authors.forename: T
authors.initials: T
authors.lastname: Harris
authors.forename: P H
authors.initials: PH
authors.lastname: Whincup
authors.forename: D G
authors.initials: DG
authors.lastname: Cook
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D011610:Psychosocial Deprivation; D055502:Secondary Prevention; D012727:Sex Characteristics; D012907:Smoking; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors