title: Statin prescribing according to gender, age and indication: what about the benefit-risk balance?
abstract: The increasing dispensing of statins has raised concern about the appropriateness of prescribing to various population groups. We aimed to (1) investigate incident and prevalent statin prescribing according to indication, gender and age and (2) relate prescribing patterns to evidence on beneficial and adverse effects.
  
  
  METHODS
  A cohort of Danish inhabitants (n = 4 424 818) was followed in nationwide registries for dispensed statin prescriptions and hospital discharge information. We calculated incidence rates (2005-2009), prevalence trends (2000-2010) and absolute numbers of statin users according to register proxies for indication, gender and age.
  
  
  RESULTS
  In 2010, the prevalence became highest for ages 75-84 and was higher in men than women (37% and 33%, respectively). Indication-specific incidences and prevalences peaked at ages around 65-70, but in myocardial infarction, the prevalence was about 80% at ages 45-80. Particularly, incidences tended to be lower in women until ages of about 60 where after gender differences were negligible. In asymptomatic individuals (hypercholesterolaemia, presumably only indication) aged 50+, dispensing was highest in women. The fraction of statin dispensing for primary prevention decreased with age: higher for incident than prevalent prescribing. Independent of age, this fraction was highest among women, e.g. 60% versus 45% at ages 55-64. The fraction for potential atherosclerotic condition (PAC, e.g. heart failure) increased with age.
  
  
  CONCLUSIONS
  Prevalence of statin utilization was highest for ages 75-84, although indication-specific measures were relatively low. Despite inconclusive evidence for a favourable risk-benefit balance, statin prescribing was high among people aged 80+, asymptomatic women and PAC patients.
authors.affiliation: Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Wallach-Kildemoes
authors.affiliation: Biostatistics, Department of Public Health, University of Aarhus, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Stovring
authors.affiliation: Section for Social and Clinical Pharmacy, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ebba
authors.initials: E
authors.lastname: Holme Hansen
authors.affiliation: Oxford Institute of Population Ageing, University of Oxford, Oxford, UK.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Howse
authors.affiliation: General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Hálfdán
authors.initials: H
authors.lastname: Pétursson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003718:Denmark; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D012737:Sex Factors; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: age; benefit-risk balance; gender; guidelines; indication; statin prescribing