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Variations and increase in use of statins across Europe: data from administrative databases

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7436.385 (Published 12 February 2004) Cite this as: BMJ 2004;328:385

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Italy: last position both in use of statins therapy and in the sensitivity of own coronary risk assessment chart

Walley and co-workers reported that Italy has the lowest
use of statins of  Europe, with
only 14.74 daily doses/1000 of population covered/day, against 23.86 in
England, 26.47 in Germany, 30.85 in France, 59.28 in Norway [1]. They suppose
that this low use may reflect low coronary morbidity of o poor adherence of
Italian patients to statins, worse than elsewhere in Europe. Really, the
reference to this sentence proved only that the adherence to statins is worse
in Bologna (Italy) than in Funen (Denmark), and ten years ago, from 1994 to
1996 [2].

On
the contrary, national guidance and policies, could be the major causes of the
Italian situation too. In the same number of the BMJ  
Raithatha and Smith reported that may people who could benefit from
statins are not currently receiving them, largely for economic reason [3]. In
Italy the reimbursement of the statins therapy is regulated by the Unique
Commission of Drugs (CUF). The rule number 13 of the CUF recommends the
statins treatment only for people with high global risk and recommends also to
use the Italian Risk Chart to estimate the global risk.

In
a previous experience we demonstrate that the first edition of the Italian
Risk Chart[4] had a very low
sensitivity, since more than 80% of patients at risk for coronary disease, so
classified by the Framingham equation[5], were misdiagnosed.

To
this aim, we employed the Italian chart to estimate how many subjects would
have been treated with statins in a population including 536 healthy blood
donors and 213 patients with non-insulin dependent diabetes mellitus. Results
were compared with those calculated by using the Framingham equation as
reference method and with alternative risk assessment screening methods,
including the New Zealand chart [6], the new Sheffield tables [7], the chart
of the Joint Task Force of European Societies on Coronary Prevention [8], and
criteria of the Joint British Societies [9].

Only
1,7% of a donors population and only 9,5% of a diabetic population should have
been admitted the a statins therapy, according to the chart (table). But only
a private prescription could be proposed to the other 80% of patient with high
risk.

In
the last weeks the Italian High Institute of Health, who realized the first
risk Chart, modified the risk classes, improving the sensibility.
Notwithstanding this change, it remain one of the lowest sensitive, compared
with other European or international ones.

Table:
Comparison of the Framingham equation with alternative screening methods and
estimated risk assessment.

 

 

Donors

Diabetic
subjects

 

risk 

N.

N.
pos.

%
pos

N.

N.
pos

%
pos

Framingham
Study equation

³15%
10y

536

54

10,1%

213

141

66.2%

New
Zealand

³15%
5y

536

31

5.8%

213

102

47.9%

New
Zealand

³20% 
5y

536

6

1.1%

213

51

23.9%

New
Sheffield table

³15%
10y

536

68

12.7%

213

148

69.5%

New
Sheffield table

³30%
10y

536

0

0.0%

213

20

9.4%

Joint
Task Force of European  Societies
on Coronary Prevention

³20%
10y

536

65

12.1%

213

99

46.5%

American
Heart Association

³20%
10y

536

11

2.1%

 

 

 

Joint
British Societies

³15%
y

536

46

8.6%

213

134

62.9%

Italian
risk assessment chart

M:
³20%
10y;

F:
³7%
5y

536

9

1.7%

210

20

9.5%

New
Italian risk assessment chart

M:
³20%
10y.

F:
³7%
5y

536

20

3.7%

210

143

34.0%


References

1.
Walley T, Folino-Gallo P, Schwabe U, van Ganse E; EuroMedStat group.
Variations and increase in use of statins across Europe: data from
administrative databases. BMJ. 2004 Feb 14;328:385-6.


2. Larsen J, Vaccheri A, Andersen M, Montanaro N, Bergman U. Lack of adherence
to lipid-lowering drug treatment. A comparison of utilization patterns in
defined populations in Funen, Denmark and Bologna, Italy.Br J Clin Pharmacol.
2000 May;49:463-71.


3. Raithatha N, Smith RD.  Paying
for statins. BMJ. 2004 Feb 14;328:400-2.

4.
Menotti A, Lanti M, Puddu PE, Carratelli L, Mancini M, Motolese M, Prati P,
Zanchetti A. An Italian chart for cardiovascular risk prediction. Its
scientific basis. Ann Ital Med Int 2001;16:240-51.

5.
Anderson KM, Odell PM, Wilson WF, Kannel WB. Cardiovascular disease risk
profile. Am Hearth J 1990;121:293-8.

6.
Wallis EJ, Ramsay LE, Ul Haq I, Ghahramani P, Jackson PR, Rowland-Yeo K, Yeo
WW. Coronary and cardiovascular risk estimation for primary prevention:
validation of a new Sheffield table in the 1995 Scottish health survey
population. BMJ. 2000;320:671-6.

7.
Jackson R. Updated New Zealand cardiovascular disease risk-benefit prediction
guide. BMJ. 2000 Mar 11;320(7236):709-10.

8.
Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyorala K. Prevention of
coronary heart disease in clinical practice: recommendations of the Second
Joint Task Force of European and other Societies on Coronary Prevention.
Atherosclerosis. 1998;140:199-270

9.
British Cardiac Society, British Hyperlipidaemia Association, British
Hypertension Society, and British Diabetic Association. Joint British
recommendations on prevention of coronary heart disease in clinical practice:
summary. BMJ 2000; 320: 705-708.

Competing interests: None declared

Competing interests:  

20 February 2004
Giavarina Davide
Clinical Chemistry and Haematology Laboratory
San Bortolo Hospital, 36100 Vicenza, (Italy)