title: A victory for statins or a defeat for diet policies? Cholesterol falls in Poland in the past decade: A modeling study.
abstract: OBJECTIVE
  The present study is aimed to examine whether recent changes in population total cholesterol (TC) levels in Poland might be attributed to increased use statins.
  
  
  METHODS
  Two independent, nationally representative cross-sectional studies were conducted in adults aged 18-79 years in 2002 (n=2993, mean age 46.2 years) and 2011 (n=2413, mean age 45.8 years), including measurements of TC in venous blood samples. The mean change of TC between 2002 and 2011 was assessed. Then the expected therapeutic reduction in TC level in 2011 attributable to statins only was calculated based on already published statin effectiveness data. Uncertainty was quantified using probabilistic sensitivity analysis.
  
  
  RESULTS
  Statin uptake in Poland rose to 11.2% in 2011 (95% Confidence Intervals (CI): 10% to 12.5%) and approximately 32% (95% CI: 28.4 to 36.0%) in subjects aged 60-79 years. Mean TC in Poland in 2002 was 5.35 mmol/l, and fell by 0.21 mmol/l (95% CI: 0.14 to 0.28) by 2011. This fall would have been only 0.03 mmol/l (95% CI: -0.04 to 0.10) for the total adult population and 0.06 mmol/l (95% CI: -0.09 to 0.22) in people aged 60-79 years if statins had not been used. Statin use thus apparently explained approximately 85% (95% CI: 49% to 120%) of the observed decrease.
  
  
  CONCLUSIONS
  Between 2002 and 2011, statin medications apparently explained a large part of the observed fall in population cholesterol level, suggesting very little changes in population TC attributed to dietary changes.
authors.affiliation: Department of Hypertension and Diabetology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland; Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, United Kingdom. Electronic address: P.Bandosz@liv.ac.uk.
authors.forename: Piotr
authors.initials: P
authors.lastname: Bandosz
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.affiliation: Department of Hypertension and Diabetology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Rutkowski
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Kypridemos
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Guzman-Castillo
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, United Kingdom.
authors.forename: Duncan O S
authors.initials: DO
authors.lastname: Gillespie
authors.affiliation: Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, ul. Kopernika 15a, 31-501 Krakow, Poland.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Solnica
authors.affiliation: Duke Clinical Research Institute, Biostatistics and Bioinformatics, Duke University, 2400 Pratt St., Durham, NC 27705, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Department of Hypertension and Diabetology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Wyrzykowski
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.affiliation: Department of Hypertension and Diabetology, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zdrojewski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood*; D003430:Cross-Sectional Studies; D004032:Diet / Q000592:standards*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009752:Nutritional Status; D011044:Poland; D018570:Risk Assessment / Q000379:methods*; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: Cholesterol; Cross-sectional studies; Hydroxymethylglutaryl-CoA reductase inhibitors; Nutrition policy