PharmacoepidemiologyPharmacoepidemiology of statins
Section snippets
Abbreviations
- ACC/AHA
American College of Cardiology/American Heart Assocation
- ACS
acute coronary syndrome
- DUS
drug utilisation studies
- EUROASPIRE IV
European Action on Secondary and Primary Prevention by Intervention to Reduce Events
- HMG-CoA
3-hydroxy-3-methylglutaryl coenzyme A
- ISPOR
International Society for Pharmacoeconomics and Outcomes Research
- MINAP
Myocardial Ischaemia National Audit Project
- REACH
Reduction of Atherothrombosis for Continued Health (registry)
- SWEDEHEART
Swedish Web-system for Enhancement and
Real-life drug use
Different perspectives can be distinguished for drug utilisation studies (DUS) of statins [15]. The general objectives of these studies are to measure, explain, predict or generalize what is observed but also to examine, analyse, or interpret these observations. Utilisation studies are the first descriptive step when looking at a drug.
Foremost, DUS allow to estimate prevalence (total number of users in a population during a given period) and incidence (new users in the population during a given
Effectiveness
Statins are one of the most studied drugs. Evidence from clinical trials is huge and several meta-analyses demonstrate the efficacy of statin in reducing mortality and cardiovascular events, mainly through lowering LDL-cholesterol, mainly during secondary prevention or in high cardiovascular risk patients [3], [4], [5], [63]. There is clear consensus on the benefit of statins in secondary cardiovascular prevention, although only simvastatin and pravastatin have demonstrated a reduction of
Risk
The contribution of pharmacoepidemiology to the evaluation of the risk of drugs, and especially its complementarity with pharmacovigilance, is well established [83]. Given the wide use of statins, their mechanisms of action by inhibiting cholesterol synthesis, a central element involved in the metabolism of many molecules, and the controversies surrounding these drugs, their risk assessment can be considered as somewhat unusual. Indeed, one might distinguish the known and quantified adverse
Conclusion
In the context of statin evaluation, pharmacoepidemiology has proven its usefulness to identify differences between target and joint populations and the impact of these differences on their effectiveness. Moreover, pharmacoepidemiology allows quantifying and studying the compliance of patients with this chronic treatment, whether for daily adherence or persistence over time, required to preserve the benefits of such treatment. Even if the real-world user population is older, and has more
Disclosure of interest
The authors declare that they have no competing interest.
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