Statin prescribing in Europe: A comparison of differences and potential impact on health outcomes

Introduction: Market data indicate that different statins are prescribed at non-equivalent doses across Europe. We estimated the differential effects of non-equipotent prescribing on low-density lipoprotein cholesterol (LDL-C) levels and cardiovascular (CV) risk for pravastatin, simvastatin and atorvastatin (genericisation in 2012). Methods: Median and weighted average daily doses (WADDs) of prescribed simvastatin, pravastatin and atorvastatin in 17 Western European countries (E17) were derived from IMS Health data for 2010. Dose-specific, LDL-C modifying potencies were derived from published meta-analyses. The relationship between LDL-C reduction achieved by statin therapy and CV risk reduction was derived from the recent meta-regression by the Cholesterol Treatment Trialists' Collaboration. Results: Across E17, the WADDs for pravastatin, simvastatin and atorvastatin were 27.1, 28.2 and 24.4 mg with corresponding relative LDL-C reductions of 25.7%, 35.8% and 42.0%. Assuming a pretreatment LDL-C of 4.05 mmol/L, these lipid changes would lead to CV (coronary/stroke) risk reductions of 22.9%, 31.9% and 37.5%, respectively. Conclusions: In Western Europe, atorvastatin is prescribed at a higher equivalent dose than simvastatin or pravastatin. The advantages of atorvastatin over the older statins in terms of LDL-C and CV risk reduction will be further enhanced when acquisition prices for atorvastatin fall after its loss of exclusivity in 2012.