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Secondary prevention of coronary heart disease in older British men: Extent of inequalities before and after implementation of the National Service Framework

Lookup NU author(s): Professor Sheena Ramsay


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Background: Deficiencies in implementation of secondary prevention of coronary heart disease (CHD) have been identified. We explored the extent of medication use for secondary prevention of CHD since the introduction of the National Service Framework (NSF) for CHD and the influence of patient age, social class, region and time since diagnosis in older British men. Methods: Prospective study in 24 British towns using patient information on medication use in 1998-2000 and 2003. Subjects were men with medically recorded diagnosis of myocardial infarction or angina, aged 62-85 years in 2003. Prevalence of medication use (aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers) in 1998-2000 and 2003 was ascertained. Results: Prevalence of use of all drugs increased in 2003 and was markedly higher in patients with a history of myocardial infarction than angina. Older age was related to lower prevalence of drug use, particularly statins. In 2000, older subjects (74-85 years) were 60% [95% confidence interval (CI) = 41-72 per cent] less likely to receive statins compared with younger subjects (62-73 years); this pattern changed very little between 2000 and 2003. Although social class appeared to have little relation to drug use, the prevalence of use of all medications decreased with increasing time since diagnosis. Conclusions: Although the uptake of medications for secondary prevention in CHD patients increased since the NSF in 2000, marked age inequalities in statin use were present both in 1998-2000 and 2003. Further action is needed to reduce these inequalities, because older patients are at particularly high risk of recurrent and fatal CHD. © The Author 2005, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Publication metadata

Author(s): Ramsay SE, Morris RW, Papacosta O, Lennon LT, Thomas MC, Whincup PH

Publication type: Article

Publication status: Published

Journal: Journal of Public Health

Year: 2005

Volume: 27

Issue: 4

Pages: 338-343

Print publication date: 01/12/2005

Online publication date: 14/09/2005

ISSN (print): 1741-3842

ISSN (electronic): 1741-3850

Publisher: Oxford University Press


DOI: 10.1093/pubmed/fdi053

PubMed id: 16162637


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