Medications—along with diet, exercise, and smoking cessation—are a cornerstone of cardiovascular risk reduction. The use of statins, which are the medication of choice for prevention, has increased substantially in North America and Europe over the past three decades, and as a result, cholesterol levels and cardiovascular mortality have decreased.
But little is known about statin use in lower-income countries. BWH researchers recently conducted an observational study of statin use in India, which has the highest burden of cardiovascular disease among less-developed nations.
The researchers found that only a fraction of those eligible for a statin actually received the therapy, despite the wide variety of statins that are available to Indian consumers.
“Low rates of statin use in India may reflect problems with access to health care, affordability, under-diagnosis, and cultural beliefs,” said Niteesh Choudhry, MD, PhD, of the BWH Division of Pharmacoepidemiology and Pharmacoeconomics, and lead author of the paper. “Because of the growing burden of cardiovascular disease in lower-income countries such as India, there is an urgent need to increase statin use and ensure access to safe products whose use is based on evidence.”
The researchers also noted that the range of statin products available in India is very broad, with many more products than the U.S. “It is striking that the low rate of use happens despite the wide availability of statin products,” Choudhry said.
The researchers conclude that the results of their study support the implementation of a broad range of policies, including the expansion of health insurance to make medications more affordable, educational activities targeted at physicians and patients to promote the prescribing and use of statins, raising awareness of the potential benefits of these drugs for appropriately selectively patients, and perhaps even introducing quality measurement activities that have been highly successful in the United States at increasing the use of evidence-based medications.