Have statins met our expectations? A comparison of expected health gains from statins with epidemiological trends in Austria

摘要

Aim As a consequence of the demonstrated efficacy in clinical studies, statins have increasingly been used in the secondary prevention of cardiovascular diseases (CVD). We aim to analyse whether expected health gains based on efficacy data can be confirmed by epidemiological trends in the Austrian population.Subjects and methods A Markov model that estimates clinical outcomes from statin treatment in secondary prevention was linked with Austrian data on statin prescription to estimate expected population health gains from 1997 to 2007. Model results are contrasted with epidemiological data on CVD mortality and morbidity. Results Among approximately 600,000 persons who took statins between 1996 and 2006, it was estimated that 860 fewer cases of unstable angina, 26,000 fewer myocardial infarcts (Mis), 1,100 fewer strokes, and roughly 25,000 more cases of stable angina occurred compared to non-medical prevention. In contrast, observed epidemiological trends indicate an increase in CVD morbidity. Furthermore, the model demonstrated 10,300 avoided/postponed fatal CVD events in Austria. Decreasing coronary heart disease (CHD) and MI mortality rates in the model are congruent with the observed epidemiology.Conclusion Tentative evidence exists that statins may have contributed to decreasing CHD mortality in Austria, whereas the expected benefits with respect to CHD morbidity and related revascularisation interventions could not be verified.