Trends in secondary prevention of ischaemic heart disease in the UK 1994-2005: use of individual and combination treatment

Stephen DeWilde ¹, Iain M Carey ¹, Nicky Richards ², Peter H Whincup ¹ and Derek G Cook ^1*

¹ St George's, University of London, United Kingdom
² Cegedim Ltd, United Kingdom

^* To whom correspondence should be addressed. E-mail: d.cook{at}sgul.ac.uk.

Accepted 6 March 2007

Abstract

Objective Statins, antiplatelet drugs, beta-blockers and ACE-inhibitors may produce marked benefits in secondary prevention of ischaemic heart disease (IHD), especially in combination. We examine trends in treatment and factors associated with treatment using a population based general practice database.

Design Analysis of routinely collected computerised data from 201 general practices using iSOFT software contributing to the DIN-LINK database.

Setting and patients Subjects aged over 35 years registered with the practices; on average, 30,000 men and 21,000 women with IHD each year.

Main outcome measure % of subjects with IHD receiving individual drugs and combined treatment in any given year.

Methods Between 1994 and 2005 use of medications for secondary prevention increased markedly. By 2005, 80% of men and 70% of women were on a statin, 75% and 74% were on antiplatelet drugs, 55% and 48% were on beta-blockers and 57% and 51% were on an ACE inhibitor; 55% of men and 46% of women were receiving a statin, antiplatelet drug and either beta-blocker or ACE-inhibitor, of whom just under half were receiving all 4 classes of drug. Gender differences were largely explained by more severe disease in men. In 2005, subjects less likely to receive combination therapy were older, had not had an MI or revascularisation, and lacked co-morbidities such as diabetes or hypertension.

Conclusions Despite high levels of statin and antiplatelet prescribing, opportunities exist for increasing the benefits of secondary prevention, especially through the wider use of combined treatments. Future targets could usefully include combination therapy.

Keywords: anti-hypertensive drugs, antiplatelets, combination therapy, secondary prevention, statins

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