title: Under-utilisation of preventive medication in patients with cardiovascular disease is greatest in younger age groups (PREDICT-CVD 15).
abstract: BACKGROUND
  Blood pressure-lowering (BPL) and lipid-lowering (LL) medications together reduce estimated absolute five-year cardiovascular disease (CVD) risk by >40%. International studies indicate that the proportion of people with CVD receiving pharmacotherapy increases with advancing age.
  
  
  OBJECTIVE
  To compare BPL and LL medications, by sociodemographic characteristics, for patients with known CVD in primary care settings.
  
  
  METHODS
  The study population included patients aged 35-74 with known CVD assessed in primary care from July 2006 to October 2009 using a web-based computerised decision support system (PREDICT) for risk assessment and management. Clinical data linked anonymously to national sociodemographic and pharmaceutical dispensing databases. Differences in dispensing BPL and LL medications in six months before first PREDICT assessment was analysed according to age, sex, ethnicity and deprivation.
  
  
  RESULTS
  Of 7622 people with CVD, 1625 <55 years old, 2862 were women and 4609 lived in deprived areas (NZDep quintiles 4/5). The study population included 4249 European, 1556 Maori, 1151 Pacific and 329 Indian peoples. BPL medications were dispensed to 81%, LL medications to 73%, both BPL and LL medications to 67%, and 87% received either class of medication. Compared with people aged 65-75, people aged 35-44 were 30-40% less likely and those aged 45-54 were 10-15% less likely to be dispensed BPL, LL medications or both. There were minimal differences in likelihood of dispensing according to sex, ethnicity or deprivation.
  
  
  CONCLUSIONS
  BPL and LL medications are under-utilised in patients with known CVD in New Zealand. Only two-thirds of patients in this cohort are on both. Younger patients are considerably less likely to be on recommended medications.
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, PB 92019 Auckland, New Zealand. suneela.mehta@auckland.ac.nz
authors.forename: Suneela
authors.initials: S
authors.lastname: Mehta
authors.forename: Sue
authors.initials: S
authors.lastname: Wells
authors.forename: Tania
authors.initials: T
authors.lastname: Riddell
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerr
authors.forename: Romana
authors.initials: R
authors.lastname: Pylypchuk
authors.forename: Roger
authors.initials: R
authors.lastname: Marshall
authors.forename: Shanthi
authors.initials: S
authors.lastname: Ameratunga
authors.forename: Wing Cheuk
authors.initials: WC
authors.lastname: Chan
authors.forename: Simon
authors.initials: S
authors.lastname: Thornley
authors.forename: Sue
authors.initials: S
authors.lastname: Crengle
authors.forename: Jeff
authors.initials: J
authors.lastname: Harrison
authors.forename: Paul
authors.initials: P
authors.lastname: Drury
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
authors.forename: Fionna
authors.initials: F
authors.lastname: Bell
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000517:prevention & control; D020000:Decision Support Systems, Clinical; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011320:Primary Health Care / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents