Quantifying the Contribution of Statins to the Decline in Population Mean Cholesterol by Socioeconomic Group in England 1991 - 2012: A Modelling Study
Open accessAbstract
BACKGROUND: Serum total cholesterol is one of the major targets for cardiovascular disease prevention. Statins are effective for cholesterol control in individual patients. At the population level, however, their contribution to total cholesterol decline remains unclear. The aim of this study was to quantify the contribution of statins to the observed fall in population mean cholesterol levels in England over the past two decades, and explore any differences between socioeconomic groups. METHODS AND FINDINGS: This is a modelling study based on data from the Health Survey for England. We analysed changes in observed mean total cholesterol levels in the adult England population between 1991-92 (baseline) and 2011-12. We then compared the observed changes with a counterfactual 'no statins' scenario, where the impact of statins on population total cholesterol was estimated and removed. We estimated uncertainty intervals (UI) using Monte Carlo simulation, where confidence intervals (CI) were impractical. In 2011-12, 13.2% (95% CI: 12.5-14.0%) of the English adult population used statins at least once per week, compared with 1991-92 when the proportion was just 0.5% (95% CI: 0.3-1.0%). Between 1991-92 and 2011-12, mean total cholesterol declined from 5.86 mmol/L (95% CI: 5.82-5.90) to 5.17 mmol/L (95% CI: 5.14-5.20). For 2011-12, mean total cholesterol was lower in more deprived groups. In our 'no statins' scenario we predicted a mean total cholesterol of 5.36 mmol/L (95% CI: 5.33-5.40) for 2011-12. Statins were responsible for approximately 33.7% (95% UI: 28.9-38.8%) of the total cholesterol reduction since 1991-92. The statin contribution to cholesterol reduction was greater among the more deprived groups of women, while showing little socio-economic gradient among men. CONCLUSIONS: Our model suggests that statins explained around a third of the substantial falls in total cholesterol observed in England since 1991. Approximately two thirds of the cholesterol decrease can reasonably be attributed non-pharmacological determinants.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In certain Western nations, statin use may account for a large proportion of declining blood cholesterol after 2000; however, due to relatively low use for primary prevention prior to this period, statins cannot explain the observed similar declines in blood cholesterol over the preceding 20-30 years.
“In certain Western nations, statin use may account for a large proportion of declining blood cholesterol after 2000;347, 348 however, due to relatively low use for primary prevention prior to this period, statins cannot explain the observed similar declines in blood cholesterol over the preceding 20-30 years.”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [348]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
Global status report on noncommunicable diseases 2010.
Alwan, A. (2011) · Cited by 8,494 · see citing works
Stone, N. J., Robinson, J. G., Lichtenstein, A. H., Bairey Merz, C. N., Blum, C. B., Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D. M., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437738.63853.7a · Cited by 7,081 · see citing works
Sick individuals and sick populations
Rose, G. (2001) · International Journal of Epidemiology · doi:10.1093/ije/30.3.427 · Cited by 3,736 · see citing works
Analysis of Complex Survey Samples
Lumley, T. (2004) · Journal of Statistical Software · doi:10.18637/jss.v009.i08 · Cited by 2,425 · see citing works
Cochran, W. G., & الفتاح, ع. ا. ع. (1978) · Al-Maǧallaẗ Al-Miṣriyyaẗ Lil Dirāsāt Al-Tiǧāriyyaẗ /Al-Maǧallaẗ Al-Miṣriyyaẗ Lil Dirāsāt Al-Tiǧāriyyaẗ · doi:10.21608/alat.1978.219785 · Cited by 2,203 · see citing works
Law, M. R., Wald, N. J., & Rudnicka, A. R. (2003) · BMJ · doi:10.1136/bmj.326.7404.1423 · Cited by 1,720 · see citing works
Sampling Techniques. 3rd Edition
Cochran, W. G. (1977) · Zenodo · doi:10.5281/zenodo.15338807 · Cited by 1,136 · see citing works
Hippisley-Cox, J., Coupland, C., Vinogradova, Y., Robson, J., May, M., & Brindle, P. (2007) · British medical journal · doi:10.1136/bmj.39261.471806.55 · Cited by 1,070 · see citing works
Jones, P., Kafonek, S., Laurora, I., & Hunninghake, D. (1998) · The American Journal of Cardiology · doi:10.1016/s0002-9149(97)00965-x · Cited by 1,067 · see citing works
Drozdzowska, B., Pluskiewicz, W., Halaba, Z. P., Misiołek, H., & Beck, B. R. (2005) · Cited by 984 · see citing works
Coronary heart disease statistics.
Allender, S. E., Peto, V., Scarborough, P., Kaur, A., & Rayner, M. (2008) · Deakin Research Online (Deakin University) · Cited by 928 · see citing works
Ünal, B., Critchley, J., & Capewell, S. (2004) · Circulation · doi:10.1161/01.cir.0000118498.35499.b2 · Cited by 740 · see citing works
Self-citationDiet, Serum Cholesterol, and Death from Coronary Heart Disease
Shekelle, R. B., Shryock, A. M., Paul, O., Lepper, M. H., Stamler, J., Liu, S., & Raynor, W. J. (1981) · New England Journal of Medicine · doi:10.1056/nejm198101083040201 · Cited by 714 · see citing works
Farzadfar, F., Finucane, M. M., Danaei, G., Pelizzari, P. M., Cowan, M. J., Paciorek, C. J., Singh, G. M., Lin, J. K., Stevens, G. A., Riley, L. M., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62038-7 · Cited by 513 · see citing works
Johnson, C. L. (1993) · JAMA · doi:10.1001/jama.269.23.3002 · Cited by 469 · see citing works
Factors associated with medication refill adherence in cardiovascular-related diseases
Gazmararian, J. A., Kripalani, S. B., Miller, M. J., Echt, K. V., Ren, J., & Rask, K. J. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00591.x · Cited by 351 · see citing works
Will Cardiovascular Disease Prevention Widen Health Inequalities?
Capewell, S., & Graham, H. M. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000320 · Cited by 329 · see citing works
Self-citationSuboptimal statin adherence and discontinuation in primary and secondary prevention populations
Ellis, J. J., Erickson, S. R., Stevenson, J. G., Bernstein, S. J., Stiles, R. A., & Fendrick, A. M. (2004) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2004.30516.x · Cited by 318 · see citing works
Capewell, S., Morrison, C. E., & McMurray, J. J. V. (1999) · Heart · doi:10.1136/hrt.81.4.380 · Cited by 309 · see citing works
Self-citationCollins, P. G. S., & Altman, D. G. (2012) · BMJ · doi:10.1136/bmj.e4181 · Cited by 245 · see citing works
Quality and Outcomes Framework: what have we learnt?:
Roland, M., & Guthrie, B. (2016) · BMJ · doi:10.1136/bmj.i4060 · Cited by 215 · see citing works
Changes in Diet in Finland from 1972 to 1992: Impact on Coronary Heart Disease Risk
Pietinen, P., Vartiainen, E. A., Seppänen, R., Aro, A., & Puska, P. (1996) · Preventive Medicine · doi:10.1006/pmed.1996.0053 · Cited by 196 · see citing works
Edwards, J. E., & Moore, R. A. (2003) · BMC Family Practice · doi:10.1186/1471-2296-4-18 · Cited by 166 · see citing works
Bajekal, M., Scholes, S., Love, H., Hawkins, N., O'Flaherty, M., Raine, R., & Capewell, S. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001237 · Cited by 159 · see citing works
Self-citationCohen, J. D., Cziraky, M. J., Cai, Q., Wallace, A. E., Wasser, T., Crouse, J. R., & Jacobson, T. A. (2010) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2010.05.030 · Cited by 151 · see citing works
Cífková, R., Škodová, Z., Bruthans, J., Adámková, V., Jozífová, M., Galovcová, M., Wohlfahrt, P., Krajčoviechová, A., Poledne, R., Stávek, P., et al. (2010) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2010.04.007 · Cited by 145 · see citing works
Population-level changes to promote cardiovascular health
Jørgensen, T., Capewell, S., Prescott, E., Allender, S. E., Sans, S., Zdrojewski, T. R., Bacquer, D. D., SUTTER, J. D., Franco, O. H., Løgstrup, S., et al. (2012) · European Journal of Preventive Cardiology · doi:10.1177/2047487312441726 · Cited by 145 · see citing works
Self-citationDifferent Time Trends of Caloric and Fat Intake Between Statin Users and Nonusers Among US Adults
Sugiyama, T., Tsugawa, Y., Tseng, C., Kobayashi, Y., & Shapiro, M. F. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.1927 · Cited by 144 · see citing works
The standard error of a weighted mean concentration—I. Bootstrapping vs other methods
Gatz, D. F., & Smith, L. A. (1995) · Atmospheric Environment · doi:10.1016/1352-2310(94)00210-c · Cited by 122 · see citing works
Coronary Heart Disease Statistics 2012
Townsend, N. P., Wickramasinghe, K., Bhatnagar, P., Smolina, K., Nichols, M., Leal, J. B., Luengo-Fernández, R., & Rayner, M. (2012) · Cited by 116 · see citing works
Scholes, S., Bajekal, M., Love, H., Hawkins, N. M., Raine, R., O’Flaherty, M., & Capewell, S. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-129 · Cited by 109 · see citing works
Self-citationHippisley‐Cox, J., Parker, C., Coupland, C. A. C., & Vinogradova, Y. (2007) · Heart · doi:10.1136/hrt.2006.110171 · Cited by 102 · see citing works
Impact of adherence to statins on coronary artery disease in primary prevention
Bouchard, M.-H., Dragomir, A., Blais, L., Bérard, A., Pilon, D., & Perreault, S. (2007) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2006.02828.x · Cited by 101 · see citing works
Intakes and major dietary sources of cholesterol and phytosterols in the British diet
Morton, G. M., Lee, S. M., Buss, D. H., & Lawrance, P. (1995) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.1995.tb00338.x · Cited by 99 · see citing works
Thomsen, R. W., Johnsen, S. P., Olesen, A. V., Mortensen, J. T., Bøggild, H., Olsen, J., & Sørensen, H. T. (2005) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2005.02494.x · Cited by 94 · see citing works
Brunner, E. J., Marmot, M. G., White, I. R., O'Brien, J. R., Etherington, M. D., Slavin, B. M., Kearney, E. M., & Smith, G. D. (1993) · Atherosclerosis · doi:10.1016/0021-9150(93)90162-n · Cited by 93 · see citing works
Eliasson, M., Janlert, U., Jansson, J.-H., & Stegmayr, B. G. (2006) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.2006.01730.x · Cited by 88 · see citing works
Ashworth, M. J., Lloyd, D. C., Smith, R. S., Wagner, A., & Rowlands, G. (2006) · Journal of Public Health · doi:10.1093/pubmed/fdl068 · Cited by 77 · see citing works
Adherence to preventive statin therapy according to socioeconomic position
Wallach‐Kildemoes, H., Andersen, M. T., Diderichsen, F., & Lange, T. (2013) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-013-1488-6 · Cited by 71 · see citing works
Diet, serum cholesterol, and death from coronary heart disease
Kaye, B. L., & B, S. R. (1981) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-198110000-00138 · Cited by 69 · see citing works
Wu, J., Zhu, S., Yao, G., Mohammed, M. A., & Marshall, T. P. (2013) · PLoS ONE · doi:10.1371/journal.pone.0067611 · Cited by 69 · see citing works
Změny na úrovni populace zaměřené na podporu kardiovaskulárního zdraví
Jørgensen, T., Capewell, S., Prescott, E., Allender, S. E., Sans, S., Zdrojewski, T. R., Bacquer, D. D., Sutter, J., Franco, O. H., Løgstrup, S., et al. (2012) · RePub (Erasmus University Rotterdam) · Cited by 69 · see citing works
Self-citationValsta, L. M., Tapanainen, H., Sundvall, J., Laatikainen, T. K., Männistö, S., Pietinen, P., & Vartiainen, E. A. (2010) · Public Health Nutrition · doi:10.1017/s1368980010001126 · Cited by 55 · see citing works
Statin prescribing in Australia: socioeconomic and sex differences
Stocks, N., McElroy, H. J., Ryan, P. J., & Allan, J. (2004) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2004.tb05891.x · Cited by 53 · see citing works
Why have total cholesterol levels declined in most developed countries?
Capewell, S., & Ford, E. S. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-641 · Cited by 49 · see citing works
Self-citationKong, S. X., Crawford, S. Y., Gandhi, S., Seeger, J. D., Schumock, G. T., Lam, N. P., Stubbings, J., & Schoen, M. D. (1997) · Clinical Therapeutics · doi:10.1016/s0149-2918(97)80102-6 · Cited by 34 · see citing works
Recognizing and improving patient nonadherence to statin therapy
Chaudhry, H. J., & McDermott, B. P. (2008) · Current Atherosclerosis Reports · doi:10.1007/s11883-008-0004-4 · Cited by 33 · see citing works
Ohlsson, H., Lynch, K. F., & Merlo, J. (2009) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2008.081166 · Cited by 22 · see citing works
Health Survey for England, 2012
Research, N. S., & University College London, D. O. E. (2014) · UK Data Archive · doi:10.5255/ukda-sn-7480-1 · Cited by 22 · see citing works
Open letter raises concerns about NICE guidance on statins
Wise, J. (2014) · BMJ · doi:10.1136/bmj.g3937 · Cited by 21 · see citing works
Cholesterol treatment with statins: Who is left out and who makes it to goal?
Franks, P. J., Tancredi, D. J., Winters, P., & Fiscella, K. A. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-68 · Cited by 18 · see citing works
Þórsson, B., Steingrímsdóttir, L., Halldórsdóttir, S., Andersen, K. K., Sigurdsson, G. T., Aspelund, T., & Gudnason, V. G. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs395 · Cited by 17 · see citing works
Health Survey for England, 2011
University College London, D. O. E., & Research, N. S. (2013) · UK Data Archive · doi:10.5255/ukda-sn-7260-1 · Cited by 17 · see citing works
Statins, saving lives, and shibboleths
Blackman, T. (2007) · BMJ · doi:10.1136/bmj.39163.563519.55 · Cited by 13 · see citing works
Health Survey for England, 1991-1992 : Combined Data File
of Population Censuses, O. (2025) · UK Data Archive · doi:10.5255/ukda-sn-3238-1 · Cited by 3 · see citing works
Afshin, A., Micha, R., Khatibzadeh, S., Fahimi, S., Shi, P., Singh, G. M., Yakoob, M. Y., Ezzati, M., & Mozaffarian, D. (2012) · Circulation · doi:10.1161/circ.125.suppl_10.ap360 · Cited by 2 · see citing works
Declining Serum Total Cholesterol Levels Among US Adults
Johnson, C. L. (1993) · JAMA · doi:10.1001/jama.1993.03500230084034
Flagged first, then by citations
Cited by
Sorted by citations
Mozaffarian, D. (2016) · Circulation · doi:10.1161/circulationaha.115.018585 · Cited by 2,216 · see citing works
Repositioning of the global epicentre of non-optimal cholesterol
Taddei, C., Zhou, B., Bixby, H., Carrillo-Larco, R. M., Danaei, G., Jackson, R., Farzadfar, F., Sophiea, M. K., Cesare, M. D., Iurilli, M. L., et al. (2020) · Nature · doi:10.1038/s41586-020-2338-1 · Cited by 304 · see citing works
Self-citationTrends in lipid-modifying agent use in 83 countries
Blais, J. E., Wei, Y., Yap, K. K. W., Alwafi, H. H., Ma, T., Brauer, R., Lau, W. C. Y., Man, K. K. C., Siu, C. W., Tan, K. C. B., et al. (2021) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2021.05.016 · Cited by 131 · see citing works
Brown, A. F., Liang, L.-J., Vassar, S., Escarce, J., Merkin, S., Cheng, E. M., Richards, A., Seeman, T., & Longstreth, W. (2018) · Annals of Internal Medicine · doi:10.7326/m17-0996 · Cited by 110 · see citing works
Cheema, K., Dicks, E., Pearson, J. D., & Samani, N. J. (2022) · Cardiovascular Research · doi:10.1093/cvr/cvac053 · Cited by 41 · see citing works
Bacquer, D. D., Smedt, D. D., Reiner, Ž., Tokgözoğlu, L. S., Clays, E., Kotseva, K., Rydén, L., Wood, D., & Backer, G. D. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319874898 · Cited by 29 · see citing works
Relationship between Statin Utilization and Socioeconomic Deprivation in Hungary
Boruzs, K., Juhász, A., Nagy, C., Ádány, R., & Bíró, K. (2016) · Frontiers in Pharmacology · doi:10.3389/fphar.2016.00066 · Cited by 21 · see citing works
Engell, A. E., Jørgensen, H. L., Lind, B., Pottegård, A., Andersen, C. L., Andersen, J. S., Kriegbaum, M., Grand, M. K., & Bathum, L. (2021) · Lipids in Health and Disease · doi:10.1186/s12944-021-01579-6 · Cited by 10 · see citing works
Brisis, Y. D. D., Jain, L., Bennett, J. E., Zhou, B., Gregg, E. W., Barradas‐Pires, A., Carrillo-Larco, R. M., Galeazzi, A., Deo, F., O'Driscoll, O. N., et al. (2026) · The Lancet · doi:10.1016/s0140-6736(26)00758-0 · Cited by 2 · see citing works
Rosenhouse‐Dantsker, A., Slayden, A. V., & Bukiya, A. N. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-85857-1.00002-x · Cited by 1 · see citing works
Faculty Opinions recommendation of Repositioning of the Global Epicentre of Non-Optimal Cholesterol.
Fazio, S. (2020) · Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature · doi:10.3410/f.738066204.793575448
Engell, A. E., Jørgensen, H. L., Lind, B., Pottegård, A., Andersen, C. L., Andersen, J. S., Kriegbaum, M., Grand, M. K., & Bathum, L. (2021) · Figshare · doi:10.6084/m9.figshare.16909963
Engell, A. E., Jørgensen, H. L., Lind, B., Pottegård, A., Andersen, C. L., Andersen, J. S., Kriegbaum, M., Grand, M. K., & Bathum, L. (2021) · Figshare · doi:10.6084/m9.figshare.16909966
Engell, A. E., Jørgensen, H. L., Lind, B., Pottegård, A., Andersen, C. L., Andersen, J. S., Kriegbaum, M., Grand, M. K., & Bathum, L. (2021) · Figshare · doi:10.6084/m9.figshare.16909969
Taheri, E., Esmaeili, S., Hamidizadeh, S., Seighali, N., Mehrpour, A., Beiky, M., Javazm, A. K., Soltani, H., Ahmadi, A., Basirat, E., et al. (2026) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2026.120725
- Authors
- Kypridemos, C., Bandosz, P., Hickey, G. L., Guzman-Castillo, M., Allen, K., Buchan, I., Capewell, S., & O’Flaherty, M.
- Affiliations
- University of Liverpool (GB)
- University of Manchester (GB)
- Corresponding author
- Kypridemos, Chris
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-04-09
- Volume
- 10
- Issue
- 4
- Pages
- e0123112
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4391910
- OpenAlex
- W2088162558
- Cited by
- 15
- References
- 60
- Citations by year
- 2026: 2 · 2022: 2 · 2021: 5 · 2020: 2 · 2019: 1 · 2018: 1 · 2016: 2
- FWCI
- 1.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research
- Medical Research Council (MR/K006665/1, MC_PC_13042)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- statins, socioeconomic disparities, socioeconomic deprivation, counterfactual modeling, cardiovascular disease prevention, statin use, women, England, Health Survey for England, uncertainty intervals, Monte Carlo simulation, cardiovascular risk reduction, health disparities, health policy evaluation
- MeSH terms
- Adolescent, Adult, Aged, Cardiovascular Diseases, Cholesterol, England, Female, Humans, Male, Middle Aged, Monte Carlo Method, Social Class, Confidence Intervals, Hydroxymethylglutaryl-CoA Reductase Inhibitors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
