Inequities in statin adherence for primary prevention of cardiovascular disease: a historical cohort study in English primary care
File(s)
Published version (Corrected Proof)
Author(s)
de La Harpe, Roxane
Muzambi, Rutendo
Bhaskaran, Krishnan
Eastwood, Sophie
Herrett, Emily
Type
Journal Article
Abstract
Aims:
Cardiovascular disease (CVD) is a leading global health concern. Statins are effective in reducing CVD risk, but suboptimal adherence limits their potential, yet recent data on this issue is limited, particularly regarding its association with socioeconomic deprivation and ethnicity.
Methods and results:
We analysed English primary care data from the CPRD Aurum database for individuals aged 25 and older who started statin therapy between 1st January 2015 and 31st December 2019, with no prior CVD. Prescription-refill data were used to calculate the proportion of days covered (PDC) within 1 year. We used logistic regression to examine the relationship between socioeconomic deprivation or ethnicity and suboptimal statin adherence (defined as a PDC < 80%) adjusted for age, sex, year of statin prescription, deprivation or ethnicity, comorbidities, smoking, and BMI status. We also assessed whether sex might modify these associations. Among the 337 990 individuals included, 32.9% had suboptimal statin adherence. Deprivation was associated with an 11% increase in odds of suboptimal adherence (OR 1.11, 95% CI: 1.08–1.13). All ethnic minorities had higher odds of suboptimal adherence compared with the White group (Black: OR 2.00, 1.92–2.08; Mixed: OR 1.49, 1.41–1.56; South Asian: OR 1.35, 1.31–1.39). Men in deprived areas and of South Asian ethnicity background had higher odds of suboptimal adherence.
Conclusion:
Suboptimal statin adherence remains a significant issue and a missed opportunity to reduce CVD burden. Adherence inequities exist, and targeted interventions are necessary to address these disparities.
Cardiovascular disease (CVD) is a leading global health concern. Statins are effective in reducing CVD risk, but suboptimal adherence limits their potential, yet recent data on this issue is limited, particularly regarding its association with socioeconomic deprivation and ethnicity.
Methods and results:
We analysed English primary care data from the CPRD Aurum database for individuals aged 25 and older who started statin therapy between 1st January 2015 and 31st December 2019, with no prior CVD. Prescription-refill data were used to calculate the proportion of days covered (PDC) within 1 year. We used logistic regression to examine the relationship between socioeconomic deprivation or ethnicity and suboptimal statin adherence (defined as a PDC < 80%) adjusted for age, sex, year of statin prescription, deprivation or ethnicity, comorbidities, smoking, and BMI status. We also assessed whether sex might modify these associations. Among the 337 990 individuals included, 32.9% had suboptimal statin adherence. Deprivation was associated with an 11% increase in odds of suboptimal adherence (OR 1.11, 95% CI: 1.08–1.13). All ethnic minorities had higher odds of suboptimal adherence compared with the White group (Black: OR 2.00, 1.92–2.08; Mixed: OR 1.49, 1.41–1.56; South Asian: OR 1.35, 1.31–1.39). Men in deprived areas and of South Asian ethnicity background had higher odds of suboptimal adherence.
Conclusion:
Suboptimal statin adherence remains a significant issue and a missed opportunity to reduce CVD burden. Adherence inequities exist, and targeted interventions are necessary to address these disparities.
Date Issued
2025-04-18
Date Acceptance
2025-04-09
Citation
European Journal of Preventive Cardiology, 2025
ISSN
2047-4873
Publisher
Oxford University Press (OUP)
Journal / Book Title
European Journal of Preventive Cardiology
Copyright Statement
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1093/eurjpc/zwaf219
Publication Status
Published online
Date Publish Online
2025-04-18