Use of statins in the secondary prevention of coronary heart disease: is treatment equitable?

Objective: To investigate possible inequities in the use of statins for people with coronary heart disease according to a wide range of social and clinical factors. Design and setting: Cross sectional analysis of data from the Health Survey for England 1998, a population based survey. Subjects: 760 adults with coronary heart disease. Results: Only 19.9% of subjects with coronary heart disease were receiving lipid lowering drugs (151 of 760; 95% confidence interval (CI) 17.0% to 22.7%). The likelihood of receiving statins was greatly reduced for older age groups: compared with those aged less than 65 years, the odds of receiving statin treatment were 0.53 (95% CI 0.35 to 0.80) for subjects aged 65-74 years, and 0.11 (95% CI 0.06 to 0.21) for subjects aged 75 years and over. Statins were given less often to current cigarette smokers than to non-smokers (odds ratio 0.55, 95% CI 0.32 to 0.96), and to subjects with angina compared with those with a previous myocardial infarct (odds ratio 0.63, 95% CI 0.43 to 0.93). Lower levels of statin use were also seen with increasing time since diagnosis (p = 0.12). No clear associations were observed with social measures. Conclusions: Important inequalities were found in the use of statins among people with coronary heart disease, which could not be justified by evidence from the large statin trials. Proactive policies are required to ensure that the vast majority of (if not all) patients with coronary heart disease are receiving statins, regardless of age, sex, social class, smoking status, type of coronary heart disease, or time since diagnosis.