@article {4449,
	title = {Trends in statin therapy initiation during the period 2000-2010 in Israel.},
	journal = {Eur J Clin Pharmacol},
	volume = {70},
	number = {5},
	year = {2014},
	month = {2014 May},
	pages = {557-64},
	abstract = {PURPOSE: The aim of this population-based study is to describe trends in the characteristics and treatment patterns of statin initiators over the first decade of the 21st century.

METHODS: New statin use was studied retrospectively using the database of Maccabi Healthcare Services (MHS), a large Israeli health maintenance organization. Statin initiators were defined as MHS members aged >= 30 years who first purchased statins between 2000 and 2010. The starting dose was calculated in simvastatin equivalents based on the World Health Organization{\textquoteright}s daily defined dose index. Persistence was calculated as the percentage of days covered (PDC) with statins during the first year of therapy.

RESULTS: Statin initiation peaked in 2005 and decreased from 38.6 to 18.6 per 1,000 in the period 2005-2010. The average age at therapy initiation decreased from 58.9 ({\textpm} 12.0) to 54.5 ({\textpm} 11.7) years, and the average (SD) baseline low-density lipoprotein cholesterol (LDL-C) decreased from 4.2 ({\textpm} 1.1) to 4.0 ({\textpm} 0.9) mmol/l during the study period. Women were on average 3 years older than men at treatment initiation, with a higher baseline LDL-C. Among statin initiators, the prevalence of ischemic heart disease (IHD) decreased from 17.8 to 6.7 \%, and diabetes prevalence increased from 8.6 to 15.7 \%, peaking in 2008 (18.0 \%). The PDC with statins ranged between 52.9 and 57.7 \%. Simvastatin use at initiation increased from 27.5 \% in 2000 to >90 \% since 2002. Starting dose increased from 18.5 ({\textpm} 8.9) to 24.3 ({\textpm} 13.7) mg simvastatin equivalent.

CONCLUSIONS: Among the study population, statin initiators were increasingly characterized by a lower cardiovascular risk-namely, younger individuals without IHD and with a lower baseline LDL-C. These trends underscore the important shift towards statin initiation for primary prevention, as well as the need to balance between benefits and the potential side effect of statins.},
	keywords = {Cardiovascular Diseases, Databases, Factual, Drug Prescriptions, Drug Utilization Review, Health Maintenance Organizations, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Israel, Retrospective Studies},
	issn = {1432-1041},
	doi = {10.1007/s00228-013-1637-y},
	author = {Shalev, Varda and Weil, Clara and Raz, Raanan and Goldshtein, Inbal and Weitzman, Dahlia and Chodick, Gabriel}
}
