Statin treatment in a cohort of 20 212 men and women in Norway according to cardiovascular risk factors and level of education

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Use of statins reduces cardiovascular morbidity and mortality. • Little is known about educational inequalities in use of statins. WHAT THIS STUDY ADDS • In Norway in patients with no history of cardiovascular disease or diabetes, start of statin treatment was not associated with educational level after adjustment for cardiovascular risk factors. • In patients with a history of cardiovascular disease or diabetes, especially highly educated women tended to start statin treatment more often than women of low educational level. • Persistence of statin treatment did not vary by educational level. AIMS To study the influence of patients' education and cardiovascular risk factors on the probability of statin treatment. METHODS A prospective cohort study of participants in regional health surveys in Norway 2000–2002 with statin use recorded in the Norwegian Prescription Database 2004–2006 as outcome measure. Information on history of cardiovascular disease (CVD) and diabetes, lipid levels, blood pressure, use of cardiovascular drugs, body mass index, family history, smoking, physical activity, marital status and place of residence was obtained at baseline. A total of 20 212 men and women aged 40–41, 45–46 and 59–61 years who reported never use of statins were included. Educational level was retrieved from Statistics Norway. Adjusted relative risks (RR) were estimated by Poisson regression. RESULTS Whereas 655 participants reported a history of CVD or diabetes, 19 557 reported no such history. In the non‐CVD/diabetes group 1620 persons (8%) became statin users and 222 persons (34%) in the CVD/diabetes group. RR of becoming a statin user for high vs. low education increased from 0.64 [95% confidence interval (CI) 0.55, 0.73] to 0.91 (95% CI 0.79, 1.05) after adjustment in the non‐CVD/diabetes group and from 0.94 (95% CI 0.70, 1.26) to 1.35 (95% CI 1.00, 1.81) in the CVD/diabetes group. CONCLUSIONS Patients with no history of CVD/diabetes were prescribed statins according to cardiovascular risk independent of education. There was a tendency to a higher probability of statin treatment among highly educated compared with people of lower educational level in the group with a history of CVD or diabetes, after adjustment for other CVD risk factors, particularly in women.