Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database
Objectives: To estimate rates of discontinuation and restarting of statins, and to identify patient characteristics associated with either discontinuation or restarting. Design: Prospective open cohort study. Setting: 664 general practices contributing to the Clinical Practice Research Datali...
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| Format: | Article |
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BMJ Publishing Group
2016
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| Online Access: | https://eprints.nottingham.ac.uk/34505/ |
| _version_ | 1848794870511042560 |
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| author | Vinogradova, Yana Coupland, Carol Brindle, Peter Hippisley-Cox, Julia |
| author_facet | Vinogradova, Yana Coupland, Carol Brindle, Peter Hippisley-Cox, Julia |
| author_sort | Vinogradova, Yana |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Objectives: To estimate rates of discontinuation and restarting of statins, and to identify patient characteristics associated with either discontinuation or restarting.
Design: Prospective open cohort study.
Setting: 664 general practices contributing to the Clinical Practice Research Datalink in the United Kingdom. Data extracted in October 2014.
Participants: Incident statin users aged 25-84 years identified between January 2002 and September 2013. Patients with statin prescriptions divided into two groups: primary prevention and secondary prevention (those already diagnosed with cardiovascular disease). Patients with statin prescriptions in the 12 months before study entry were excluded.
Main outcome measures: Discontinuation of statin treatment (first 90 day gap after the estimated end date of a statin prescription), and restarting statin treatment for those who discontinued (defined as any subsequent prescription between discontinuation and study end).
Results: Of 431 023 patients prescribed statins as primary prevention with a median follow-up time of 137 weeks, 47% (n=204 622) discontinued treatment and 72% (n=147 305) of those who discontinued restarted. Of 139 314 patients prescribed statins as secondary prevention with median follow-up time of 182 weeks, 41% (n=57 791) discontinued treatment and 75% (43 211) of those who discontinued restarted. Younger patients (aged ≤50 years), older patients (≥75 years), women, and patients with chronic liver disease were more likely to discontinue statins and less likely to restart. However, patients in ethnic minority groups, current smokers, and patients with type 1 diabetes were more likely to discontinue treatment but then were more likely to restart, whereas patients with hypertension and type 2 diabetes were less likely to discontinue treatment and more likely to restart if they did discontinue. These results were mainly consistent in the primary prevention and secondary prevention groups.
Conclusions: Although a large proportion of statin users discontinue, many of them restart. For many patient groups previously considered as “stoppers,” the problem of statin treatment “stopping” could be part of the wider issue of poor adherence. Identification of patient groups associated with completely stopping or stop-starting behaviour has positive implications for patients and doctors as well as suggesting areas for future research. |
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| format | Article |
| id | nottingham-34505 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:23:04Z |
| publishDate | 2016 |
| publisher | BMJ Publishing Group |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-345052020-05-04T17:54:56Z https://eprints.nottingham.ac.uk/34505/ Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database Vinogradova, Yana Coupland, Carol Brindle, Peter Hippisley-Cox, Julia Objectives: To estimate rates of discontinuation and restarting of statins, and to identify patient characteristics associated with either discontinuation or restarting. Design: Prospective open cohort study. Setting: 664 general practices contributing to the Clinical Practice Research Datalink in the United Kingdom. Data extracted in October 2014. Participants: Incident statin users aged 25-84 years identified between January 2002 and September 2013. Patients with statin prescriptions divided into two groups: primary prevention and secondary prevention (those already diagnosed with cardiovascular disease). Patients with statin prescriptions in the 12 months before study entry were excluded. Main outcome measures: Discontinuation of statin treatment (first 90 day gap after the estimated end date of a statin prescription), and restarting statin treatment for those who discontinued (defined as any subsequent prescription between discontinuation and study end). Results: Of 431 023 patients prescribed statins as primary prevention with a median follow-up time of 137 weeks, 47% (n=204 622) discontinued treatment and 72% (n=147 305) of those who discontinued restarted. Of 139 314 patients prescribed statins as secondary prevention with median follow-up time of 182 weeks, 41% (n=57 791) discontinued treatment and 75% (43 211) of those who discontinued restarted. Younger patients (aged ≤50 years), older patients (≥75 years), women, and patients with chronic liver disease were more likely to discontinue statins and less likely to restart. However, patients in ethnic minority groups, current smokers, and patients with type 1 diabetes were more likely to discontinue treatment but then were more likely to restart, whereas patients with hypertension and type 2 diabetes were less likely to discontinue treatment and more likely to restart if they did discontinue. These results were mainly consistent in the primary prevention and secondary prevention groups. Conclusions: Although a large proportion of statin users discontinue, many of them restart. For many patient groups previously considered as “stoppers,” the problem of statin treatment “stopping” could be part of the wider issue of poor adherence. Identification of patient groups associated with completely stopping or stop-starting behaviour has positive implications for patients and doctors as well as suggesting areas for future research. BMJ Publishing Group 2016-06-28 Article PeerReviewed Vinogradova, Yana, Coupland, Carol, Brindle, Peter and Hippisley-Cox, Julia (2016) Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database. BMJ, 353 . i3305. ISSN 1756-1833 statin treatment; primary care; database http://www.bmj.com/content/353/bmj.i3305 doi: http://dx.doi.org/10.1136/bmj.i3305 doi: http://dx.doi.org/10.1136/bmj.i3305 |
| spellingShingle | statin treatment; primary care; database Vinogradova, Yana Coupland, Carol Brindle, Peter Hippisley-Cox, Julia Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database |
| title | Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database |
| title_full | Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database |
| title_fullStr | Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database |
| title_full_unstemmed | Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database |
| title_short | Discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database |
| title_sort | discontinuation and restarting in patients on statin therapy: a cohort study using a primary care database |
| topic | statin treatment; primary care; database |
| url | https://eprints.nottingham.ac.uk/34505/ https://eprints.nottingham.ac.uk/34505/ https://eprints.nottingham.ac.uk/34505/ |