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Observational Study
. 2025 Jun;13(3):e70122.
doi: 10.1002/prp2.70122.

Trends in Lipid-Lowering Agent Consumption in Croatia: A 25-Year Observational Study

Andrej Belančić  1 , Marta Kučan Štiglić  1 , Luka Prgomet  2 , Ivan Pećin  2   3 , Željko Reiner  2 , Dinko Vitezić  1
Affiliations
Observational Study

Trends in Lipid-Lowering Agent Consumption in Croatia: A 25-Year Observational Study

Andrej Belančić et al. Pharmacol Res Perspect. 2025 Jun.

Abstract

Cardiovascular diseases are the leading cause of mortality worldwide, with dyslipidemia as a major modifiable risk factor. This study aimed to assess 25-year trends in lipid-lowering agent consumption in Croatia from 2000 to 2023. We conducted a population-based analysis using IMS and IQVIA databases, calculating drug utilization in defined daily doses per 1000 inhabitants per day (DDD/1000) and evaluating financial expenditures and prescribing patterns. Over the study period, total lipid-lowering drug consumption increased more than 30-fold, from 4.91 DDD/1000 in 2000 to 152.56 DDD/1000 in 2023. Statins, particularly atorvastatin and rosuvastatin, drove this trend, while the uptake of PCSK9 inhibitors and ezetimibe reflected an evolving therapeutic landscape. Financial expenditures peaked in 2010, declined until 2015, and rose again by 2023, with average drug prices per DDD decreasing significantly. The observed increase in lipid-lowering therapy correlated with enhanced adherence to international guidelines and expanded patient access. However, administrative barriers and restrictive reimbursement policies continue to limit optimal utilization of newer agents. These findings underscore the importance of evidence-based policy development to address clinical inertia and improve cardiovascular outcomes in Croatia.

Keywords: cholesterol; dyslipidemia; lipid‐lowering agents; statins.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(A) Lipid‐lowering medicines consumption in Croatia during the period 2000–2023, in DDD/1000. (B) Lipid‐lowering medicines financial consumption in Croatia during the period 2000–2023, in EUR.
FIGURE 2
FIGURE 2
(A) HMG CoA reductase inhibitors consumption in Croatia during the period 2000–2023, in DDD/1000. (B) Prices per DDD for HMG CoA reductase inhibitors in Croatia during the period 2000–2023, in EUR.
FIGURE 3
FIGURE 3
(A) Individual HMG CoA reductase inhibitors consumption in Croatia during the period 2000–2023, in DDD/1000. (B) Prices per DDD for individual HMG CoA reductase inhibitors in Croatia during the period 2000–2023, in EUR.
FIGURE 4
FIGURE 4
(A) Fibrates consumption in Croatia during the period 2000–2023, in DDD/1000. (B) Prices per DDD for fibrates in Croatia during the period 2000–2023, in EUR.
FIGURE 5
FIGURE 5
(A) PCSK9 inhibitors consumption in Croatia during the period 2000–2023, in DDD/1000. (B) Prices per DDD for PCSK9 inhibitors in Croatia during the period 2000–2023, in EUR.
FIGURE 6
FIGURE 6
Share of prescribed lipid modifying drugs in combinations in Croatia from 2000 to 2023.
FIGURE 7
FIGURE 7
Deaths caused by diseases of the circulatory system in Croatia, from 2000 to 2023.
See this image and copyright information in PMC

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