The conclusion of a recent HERC study found that Cholesterol- and blood pressure-lowering drugs are underused in secondary cardiovascular prevention across Europe with substantial drug discontinuation over time and with increasing duration from an acute cardiovascular event.
Background: Suboptimal use of cardiovascular prevention medications has been reported. We report recent trends in secondary cardiovascular disease prevention drug use in Europe.
Design: We used the 2004-2013 data from the Survey of Health, Ageing and Retirement in Europe (SHARE), a large longitudinal cohort study in middle-aged and elderly Europeans.
Methods: Cross-sectional and panel data logistic regression models were used to study trends in cholesterol- and blood pressure-lowering drug use and effects of participant characteristics on the likelihood of drug use among participants with histoty of cardiovascular disease in SHARE.
Results: In SHARE 21,388 participants reported history of cardiovascular disease and provided data on cholesterol- and blood pressure-lowering drug use. At initial report, 40% and 60% of them used cholesterol- or blood pressure-lowering drugs, respectively. Increasing cross-sectional time trends were observed for both medication classes (odds ratios of use in 2013 vs. 2004, 1.6 (95% confidence interval 1.4–1.7) and 1.5 (1.4–1.6), respectively). However, among participants with multiple observations, the use of both classes declined over time (2013 vs. 2004 odds ratio 0.63 (0.51–0.77) and 0.68 (0.55–0.84), respectively; both trend p < 0.001), and with increasing duration since last cardiovascular event (odds ratio 0.74 (0.60–0.91), trend p = 0.01 and odds ratio 0.82 (0.66–1.03), trend p = 0.06, respectively for durations of nine years or more versus less than one year). Among people with history of cardiovascular disease, those obese, retired or with hypercholesterolaemia, hypertension, worse self-perceived health, and, in the case of lipid-lowering medication, with diabetes, were more likely to use these medications.
Conclusions: Despite moderately increasing cross-sectional time trends, the use of secondary cardiovascular disease prevention drugs remains low in Europe with substantial discontinuation over time and with increasing duration from an acute cardiovascular event.