Socioeconomic and ethnic differences in use of lipid-lowering drugs after deregulation of simvastatin in the UK: The Whitehall II prospective cohort study

Abstract

Background: We examined socioeconomic and ethnic differences in use of lipid-lowering drugs after deregulation of simvastatin in the UK for adults with moderate or high risk of coronary heart disease. Methods: 3631 participants in the Whitehall II cohort study (mean age 62.7. years, 91% white) were informed of their risk of coronary heart disease, based on Framingham score, before deregulation (2002-2004). The use of prescribed lipid-lowering drugs and use of over-the-counter simvastatin were analysed as outcome variables, after deregulation (2005-2007). Results: 2451 participants were at high risk and 1180 at moderate risk. 20% moderate-risk and 44% high-risk participants reported using prescribed lipid-lowering drugs although no over-the-counter simvastatin was used. Prescribing rates did not differ between employment grades (an index of socioeconomic position), but was higher among South Asian high-risk compared with White high-risk participants (odds ratio 1.64, 95% CI 1.21-2.23). Of the high-risk participants, 44% recalled their increased coronary heart disease risk. South Asian high-risk participants were less likely to recall than White high-risk participants (odds ratio 0.65, 95% CI 0.46-0.93). Furthermore, high risk participants with middle (odds ratio 0.74, 95% CI 0.61-0.89) and low (odds ratio 0.52, 95% CI 0.37-0.74) employment grades were less likely to recall than those with high grades. Conclusion: Socioeconomic and ethnic differences in reported use of lipid-lowering drugs were small, but the use of these drugs in general was much lower than recommended and the participants did not utilise over-the-counter statins. Ethnic minorities and lower socioeconomic position groups were less likely to be aware of their increased coronary risk. © 2010 Elsevier Ireland Ltd.