Underlying medical indications for statin initiation in BC over the period January 1, 1998 December 31, 2011: Analysis of temporal trends and a comparison of compliance and effectiveness
Gaps in the knowledge base
The following gaps exist in the knowledge base surrounding the use of statins in the primary and secondary prevention of coronary heart disease:
1) There is no information characterizing statin use in BC in recent years with respect to indication for use (primary versus secondary prevention; high risk vs low risk).
2) There is no information regarding the effect of statin compliance on morbidity and mortality that appropriately accounts for indication and dose.
Research Questions and Specific Objectives
Although the study described is primarily descriptive (epidemiologic) there are three underlying hypotheses that will be tested.
1) Statins have been underprescribed for BC patients at high risk for CHD (including those who
have suffered a documented CV event).
2) BC would benefit from a provincial program aimed at improvement of
3) There was a decrease in adherence consistent with an effect from greater costs being borne by the patient after
policy changes in 2002 and 2003.
We will address questions related to statin therapy in the primary and secondary prevention of coronary heart disease. We will characterize the profile of patients using statin therapy, the types of statins being used, drug compliance associated with the users, and the relationship between compliance and effectiveness. We will examine trends in statin use that reflect new knowledge gained regarding the efficacy of statin therapy as used in primary prevention. Our questions will be answered in the setting of BC, among patients receiving statin therapy for the primary and secondary prevention of coronary events.
Proposed research objectives
The overarching aim of this study is to characterize changes in statin therapy over the period 1998-2011, relating to indication for drug initiation. As the impetus for promoting primary prevention was evidence of effectiveness, we will also answer questions relating to indication, compliance, and effectiveness. Our specific research objectives are to:
1) estimate the change in the proportion of individuals initiating statin therapy for primary prevention, versus for secondary prevention between 1997 and 2011 in BC;
2) estimate the rate of statin discontinuation over time among primary and secondary prevention users of statins;
3) estimate the effect of statin use and indication on occurrence of a major coronary event.