only 14.74 daily doses/1000 of population covered/day, against 23.86 in
England, 26.47 in Germany, 30.85 in France, 59.28 in Norway [1].
They suppose that this low use may reflect low coronary morbidity of o poor adherence of
Italian patients to statins, worse than elsewhere in Europe.
Really, the reference to this sentence proved only that the adherence to statins is worse
in Bologna (Italy) than in Funen (Denmark), and ten years ago, from 1994 to
1996 [2].
On the contrary, national guidance and policies, could be the major causes of the
Italian situation too. In the same number of the BMJ Raithatha and Smith reported that may people who could benefit from statins are not currently receiving them, largely for economic reason [3]. In Italy the reimbursement of the statins therapy is regulated by the Unique
Commission of Drugs (CUF). The rule number 13 of the CUF recommends the
statins treatment only for people with high global risk and recommends also to
use the Italian Risk Chart to estimate the global risk.
Italian situation too. In the same number of the BMJ Raithatha and Smith reported that may people who could benefit from statins are not currently receiving them, largely for economic reason [3]. In Italy the reimbursement of the statins therapy is regulated by the Unique
Commission of Drugs (CUF). The rule number 13 of the CUF recommends the
statins treatment only for people with high global risk and recommends also to
use the Italian Risk Chart to estimate the global risk.
In a previous experience we demonstrate that the first edition of the Italian
Risk Chart[4] had a very low sensitivity, since more than 80% of patients at risk for coronary disease, so classified by the Framingham equation[5], were misdiagnosed.
Risk Chart[4] had a very low sensitivity, since more than 80% of patients at risk for coronary disease, so classified by the Framingham equation[5], were misdiagnosed.
To this aim, we employed the Italian chart to estimate how many subjects would
have been treated with statins in a population including 536 healthy blood
donors and 213 patients with non-insulin dependent diabetes mellitus. Results
were compared with those calculated by using the Framingham equation as
reference method and with alternative risk assessment screening methods,
including the New Zealand chart [6], the new Sheffield tables [7], the chart
of the Joint Task Force of European Societies on Coronary Prevention [8], and
criteria of the Joint British Societies [9].
have been treated with statins in a population including 536 healthy blood
donors and 213 patients with non-insulin dependent diabetes mellitus. Results
were compared with those calculated by using the Framingham equation as
reference method and with alternative risk assessment screening methods,
including the New Zealand chart [6], the new Sheffield tables [7], the chart
of the Joint Task Force of European Societies on Coronary Prevention [8], and
criteria of the Joint British Societies [9].
Only 1,7% of a donors population and only 9,5% of a diabetic population should have
been admitted the a statins therapy, according to the chart (table). But only
a private prescription could be proposed to the other 80% of patient with high
risk.
been admitted the a statins therapy, according to the chart (table). But only
a private prescription could be proposed to the other 80% of patient with high
risk.
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7436.385 (Published 12 February 2004)Cite this as: BMJ 2004;328:385
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