Determinants of Statin Prescription among Physicians in Nigeria.

BACKGROUND: The appropriate use of statins in patients' management significantly reduces their cardiovascular morbidity and mortality. This informed the advocacy for the use of guideline-based statin therapy for both primary and secondary prevention of cardiovascular diseases. However, the translation of evidence into clinical practice remains inconsistent globally, and there are limited data on factors that determine statin prescription among physicians. AIM: This study determined the awareness and use of lipid management guidelines and factors associated with the appropriate use of statins among physicians in Nigeria. METHODOLOGY: This was a descriptive cross-sectional study conducted using an online survey among physicians practising in Nigeria. Their awareness and use of relevant lipid management guidelines, concerns about statin use and knowledge on the appropriate use of statins in different clinical vignettes were assessed using closed-ended questions. Agreement between responses to high-risk and low-risk clinical vignettes was evaluated using Cohen's kappa. Factors associated with the appropriate use of statins were determined using multivariate analysis. A P ≤ 0.05 was considered statistically significant. RESULTS: A total of 315 physicians participated in the study. The majority (98.1%) were below 60 years, 65.1% were males and 37.8% were specialists. About 67.0% of the respondents reported awareness of relevant lipid guidelines, while only 27.9% reported regular use. The majority of respondents (79.0%) expressed concerns about statins, which included risk of muscle disorders (64.4%), hepatic disease (35.9%), cognitive impairment (34.9%) and new-onset diabetes (17.8%). In the high-risk clinical scenario, statins were withheld by 23.8% of respondents, while 65.7% prescribed statins in the low-risk context. Agreement between responses to the two scenarios was statistically significant (κ =0.18, standard error = 0.04, P < 0.001). In the multivariable model, awareness of relevant lipid guidelines was significantly associated with statin prescription in the high-risk scenarios (odds ratios [OR] =0.20, 95% confidence interval [CI]: 0.10-0.41, P < 0.0001), while being a specialist showed borderline association with lower odds of inappropriate prescription (OR = 0.63, 95% CI: 0.39-1.02, P = 0.059). CONCLUSION: The awareness of lipid guidelines among physicians is high, but their use is low. The majority expressed concerns about the adverse effects of statins. Awareness of lipid guidelines and specialist training were associated with appropriate statin use.