Demographic, clinical and lifestyle factors associated with high-intensity statin therapy in Australia: the AusDiab study
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Clinical guidelines specify who should receive high-intensity statins; however, it is unclear how high-intensity statins are used in Australia. Our objective was to determine the demographic, clinical, and lifestyle factors associated with high-intensity statin therapy in Australia.
Data from the Australian Diabetes, Obesity and Lifestyle study collected in 2011–2012 were analyzed. High-, moderate-, and low-intensity statins were defined as use of statins at doses demonstrated to reduce low-density lipoprotein cholesterol levels by > 50, 30–50, and < 30%, respectively. Logistic regression was used to estimate adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for factors associated with high- versus low-to-moderate-intensity statin therapy.
Overall, 1108 (24%) study participants used a statin. Data on statin intensity were available for 1072 participants. The proportions of high-, moderate-, and low-intensity statin therapy were 32 (n = 341), 65 (n = 696), and 3% (n = 35), respectively. Overall, 51% of people with prior cardiovascular disease (CVD) used a high-intensity statin. In addition to prior CVD (OR = 3.34, 95% CI = 1.95–5.73), no (OR = 1.84, 95%CI 1.02–3.31) or insufficient physical activity (OR = 1.51, 95% CI = 1.01–2.25), obesity (OR = 1.87, 95% CI = 1.13–3.10), and consuming > 2 alcoholic drinks daily (OR = 1.66, 95% CI = 1.08–2.55) were associated with high versus low-to-moderate-intensity statin therapy. Conversely, age 65–74 vs. < 65 years was inversely associated with high-intensity statin therapy (OR = 0.62, 95% CI = 0.41–0.94).
Prior CVD was the strongest factor associated with high-intensity statin therapy. Although the prevalence of CVD increases with age, older people were less likely to be treated with high-intensity statins.
KeywordsHMG-CoA reductase inhibitors Cholesterol Cardiovascular disease Epidemiology Australia
The AusDiab study, co-coordinated by the Baker IDI Heart and Diabetes Institute, gratefully acknowledges the support and assistance given by K Anstey, B Atkins, B Balkau, E Barr, A Cameron, S Chadban, M de Courten, D Dunstan, N Htun, A Kavanagh, S Murray, N Owen, K Polkinghorne, A Tonkin, T Welborn, P Zimmet, and all the study participants.
Contributions of authors statement
KH participated in conception and design of the study, data analysis, interpretation, and drafting the manuscript, and approved the final manuscript. KJ participated in conception and design of the study, data analysis, interpretation, provided critical revision of the manuscript, and approved the final manuscript. JSB participated in conception and design of the study, data analysis, interpretation, provided critical revision of the manuscript, and approved the final manuscript. MJK interpreted data, provided critical revision of the manuscript, and accepted the final version of the manuscript. KPM in conception and design of the study, data analysis, interpretation, provided critical revision of the manuscript and approved the final manuscript. DJM participated in acquisition of data, interpretation, provided critical revision of the manuscript and accepted the final version of the manuscript. DL participated in data interpretation, provided critical revision of the manuscript, and accepted the final version of the manuscript. TER-A interpreted the data, provided critical revision of the manuscript, and accepted the final version of the manuscript. JES participated in acquisition of data, interpretation, provided critical revision of the manuscript, and accepted the final version of the manuscript. SL interpreted the data, provided critical revision of the manuscript, and accepted the final version of the manuscript. JI participated in conception and design of the study, data analysis, interpretation, provided critical revision of the manuscript, and approved the final manuscript. All authors have approved the final article.
JI was supported by a National Health and Medical Research Council (NHMRC) Early Career Fellowship (1072137). KM was supported by a Heart Foundation Postdoctoral Award (100187). KJ was supported by the NHMRC Cognitive Decline Partnership Centre (GNT9100000). DJM and JES are supported by an NHMRC Senior Research Fellowships (APP1079438 and APP1118161). Also, for funding or logistical support, we are grateful to the National Health and Medical Research Council (NHMRC grants 233,200 and 1,007,544) Australian Government Department of Health and Aging, Abbott Australasia Pty Ltd., Alphapharm Pty Ltd., Amgen Australia, AstraZeneca, Bristol-Myers Squibb, City Health Centre-Diabetes Service-Canberra, Department of Health and Community Services - Northern Territory, Department of Health and Human Services – Tasmania, Department of Health – New South Wales, Department of Health – Western Australia, Department of Health – South Australia, Department of Human Services – Victoria, Diabetes Australia, Diabetes Australia Northern Territory, Eli Lilly Australia, Estate of the Late Edward Wilson, GlaxoSmithKline, Jack Brockhoff Foundation, Janssen-Cilag, Kidney Health Australia, Marian & FH Flack Trust, Menzies Research Institute, Merck Sharp & Dohme, Novartis Pharmaceuticals, Novo Nordisk Pharmaceuticals, Pfizer Pty Ltd., Pratt Foundation, Queensland Health, Roche Diagnostics Australia, Royal Prince Alfred Hospital, Sydney, Sanofi Aventis, Sanofi-Synthelabo, and the Victorian Government’s OIS Program.
Compliance with ethical standards
Conflict of interest
JES has received honoraria or grant support from Merck Sharp and Dohme, Novo Nordisk, Eli Lilly, AstraZeneca, Sanofi-Aventis, Mylan Pharmaceuticals, and Boehringer Ingelheim. Funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
All procedures performed involving human participants were in accordance with the ethical standards of the Monash University Human Research Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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