title: Time trends in statin utilisation and coronary mortality in Western European countries.
abstract: OBJECTIVE
  To determine whether there is a relation between statin utilisation and coronary heart disease (CHD) mortality in populations with different levels of coronary risk, and whether the relation changes over time.
  
  
  METHODS
  Ecological study using national databases of dispensed medicines and mortality rates.
  
  
  METHODS
  Western European countries with similar public health systems.
  
  
  METHODS
  Population CHD mortality rates (rate/100,000) as a proxy for population coronary risk level, and statin utilisation expressed as Defined Daily Dose per one Thousand Inhabitants per Day (DDD/TID), in each country, for each year between 2000 and 2012. Spearman's correlation coefficients between CHD mortality and statin utilisation were calculated. Linear regression analysis was used to assess the relation between changes in CHD mortality and statin utilisation over the years.
  
  
  RESULTS
  12 countries were included in the study. There was a wide range of CHD mortality reduction between the years 2000 and 2012 (from 25.9% in Italy to 57.9% in Denmark) and statin utilisation increase (from 121% in Belgium to 1263% in Denmark). No statistically significant relations were found between CHD mortality rates and statin utilisation, nor between changes in CHD and changes in statin utilisation in the countries over the years 2000 and 2012.
  
  
  CONCLUSIONS
  Among the Western European countries studied, the large increase in statin utilisation between 2000 and 2012 was not associated with CHD mortality, nor with its rate of change over the years. Factors different from the individual coronary risk, such as population ageing, health authority programmes, guidelines, media attention and pharmaceutical industry marketing, may have influenced the large increase in statin utilisation. These need to be re-examined with a greater emphasis on prevention strategies.
authors.affiliation: Department of Internal Medicine, Ospedale S Elia, Caltanissetta, Italy Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Federico
authors.initials: F
authors.lastname: Vancheri
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Backlund
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars-Erik
authors.initials: LE
authors.lastname: Strender
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.affiliation: Centre for Pharmacoepidemiology & Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
mesh_terms: D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality*; D016208:Databases, Factual; D005060:Europe; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D018570:Risk Assessment
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: coronary mortality; statin utilization