Burden and Predictors of Statin Use for Primary and Secondary Prevention of Cardiovascular Disease in Bangladesh: Evidence from a Nationally Representative Survey

Background: Large-scale randomized trials have established the efficacy and safety of statin therapy in preventing cardiovascular diseases (CVDs) among individuals at increased risk (i.e., primary prevention) or those with pre-existing cardiovascular disease (i.e., secondary prevention). Consequently, recent international guidelines, including those from the WHO and ACC/AHA, have expanded the eligibility criteria for statin therapy. Objective: To assess the current burden of statin-eligible populations in Bangladesh, evaluate the current state of statin use, and identify factors associated with non-use of statins. Methods: We analysed data from 3,140 adults aged 40 to 69 years from the nationally representative WHO-STEPS Bangladesh 2018 survey. Statin therapy eligibility for primary prevention was assessed using the WHO-2019 and the ACC/AHA-2018 guidelines separately. Individuals with a previous history of CVD were eligible for secondary prevention under both guidelines. Modified Poisson regression models identified factors associated with statin use. All analyses were conducted using appropriate survey weights. Findings: Among the participants, 443 (14.1%) reported a previous history of CVD. Of those without CVD, 11.2% (95% CI: 9.7-12.9) and 32.3% (95% CI: 30.0-34.6) were eligible for statin use for primary prevention according to the WHO-2019 and the ACC/ AHA-2018 guidelines, respectively. Among adults eligible according to WHO-2019 guideline, 6.9% (95% CI: 4.1-11.5) were using statins, while among those eligible according to ACC/AHA-2018 guideline, 3.3% (95% CI: 2.1-5.1) were using statins. For secondary prevention, 23.5% (95% CI: 16.9-31.6) of adults with prior CVD were using statins. Non-use was higher among younger adults, those without regular health visits or cholesterol measurements, and those from the Mymensingh or Rajshahi divisions. Interpretation: In Bangladesh, approximately one in twenty eligible individuals uses statins for primary prevention of CVD, and one in five individuals for secondary prevention. Appropriate population health interventions are needed to scale up statin use to mitigate the burden of CVD.