Cohort study investigating the relationship between cholesterol, cardiovascular risk score and the prescribing of statins in UK primary care: study protocol

Finnikin, Samuel; Ryan, Ronan; Marshall, Tom

doi:10.1136/bmjopen-2016-013120

Cited by 3 publications

(3 citation statements)

References 42 publications

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“…This suggests that even though recommended LDL-C treatment thresholds were not strictly adopted, LDL-C levels were indeed taken into account in the treatment decisions. In addition, we found that undertreatment was less common in patients at very high CV risk compared to patients at high CV risk and thereby were able to show that GPs account for the patients CV risk, which contrasted studies reporting that GPs placed too much emphasis on dyslipidemia rather than absolute CV risk [7,16,17]. Interestingly, among patients with very high CV risk in our study, those with established atherosclerotic CV disease (patients in secondary prevention) were more likely to be initiated on a statin than those without established atherosclerotic CV disease (primary prevention, Table 1).…”

Section: Discussioncontrasting

confidence: 66%

“…Given the high prevalence of increased CV risk, guideline-concordant statin treatment is of great concern. Both statin undertreatment, i.e., forgoing statin treatment for patients for whom initiation is recommended, and overtreatment, i.e., the initiation of statin treatment in patients for whom it is not recommended, have been reported [ 7 , 8 , 9 ]. Undertreatment is of highest concern, as it signifies missed opportunities to effectively decrease CV mortality.…”

Section: Introductionmentioning

confidence: 99%

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Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Rachamin

Markun

Grischott

et al. 2020

JCM

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Guidelines recommend initiation of statins depending on cardiovascular risk and low-density lipoprotein cholesterol (LDL-C) levels. In this retrospective cohort study, we aimed to assess guideline concordance of statin treatment decisions and to find determinants of undertreatment in Swiss primary care in the period 2016–2019. We drew on electronic medical records of 8060 statin-naive patients (50.0% female, median age 59 years) with available LDL-C levels and cardiovascular risk. Guideline concordance was assessed based on the recommendations of the European Society of Cardiology, and multilevel logistic regression was performed to find determinants of undertreatment. We found that statin treatment was initiated in 10.2% of patients during one year of follow up. Treatment decisions were classified as guideline-concordant in 63.0%, as undertreatment in 35.8% and as overtreatment in 1.2%. Among determinants of undertreatment were small deviation from LDL-C treatment thresholds (odds ratio per decrease by 1 mmol/L: 2.09 [95% confidence interval 1.87–2.35]), high compared with very high cardiovascular risk (1.64 [1.30–2.05]), female sex (1.31 [1.05–1.64]), and being treated by older general practitioners (per 10 year decrease: 0.74 [0.61–0.90]). In conclusion, undertreatment of patients at high or very high cardiovascular risk was common, but general practitioners considered cardiovascular risk and LDL-C in their treatment decisions.

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Section: Discussioncontrasting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Rachamin

Markun

Grischott

et al. 2020

JCM

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“…For missing data a ‘missing’ category was used. The lipid values were extracted, along with any variables that are included in the QRISK2 calculation or could influence statin prescribing (see protocol paper 31 for full list). Biologically implausible values were excluded (including cases where high-density lipoprotein [HDL] cholesterol was greater than total cholesterol [TC]).…”

Section: Methodsmentioning

confidence: 99%

Factors predicting statin prescribing for primary prevention: a historical cohort study

et al. 2020

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Background: Initiation of statins for the primary prevention of cardiovascular disease (CVD) should be based on CVD risk estimates but their use is sub-optimal. Aim: To investigate the factors influencing statin prescribing when clinicians code and do not code estimated CVD risk (QRISK2). Design and setting: A historical cohort of patients who had lipid tests in a database of UK primary care records (IMRD). Methods: The cohort comprised 686,560 entries (lipid test results) between 2012 and 2016 from 383,416 statin naïve patients, without previous CVD. Coded QRISK2 estimates were extracted, with variables used in calculating QRISK2 and factors that might influence statin prescribing. If QRISK2 was not coded, it was calculated post-hoc. The outcome was initiation of a statin within 60 days of the lipid test result. Results: 21.4% of entries had a coded QRISK2 score. Statins were initiated in 6.6% (6.4%-6.7%) of those with coded and 4.1% (4.0%-4.1%) of un-coded QRISK2 (p<0.001). Statin initiations were consistent with NICE guideline recommendations in 85.0% (84.2%-85.8%) of coded and 44.2% (43.5%-44.9%) of un-coded QRISK2 groups (P<0.001). When coded, QRISK2 score was the main predictor of statin initiation, but total cholesterol was the main predictor when QRISK2 was not coded. Conclusions: When QRISK2 is coded, prescribing is more consistent with guidelines. With no QRISK2 code, prescribing is mainly based on total cholesterol. Using QRISK2 is associated with statin prescribing that is more likely to benefit patients. Promoting the routine CVD risk estimation is essential to optimise decision making.

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The divided medical opinions of the statin debate updated

Winter

2018

British Journal of Healthcare Management

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Cohort study investigating the relationship between cholesterol, cardiovascular risk score and the prescribing of statins in UK primary care: study protocol

Cited by 3 publications

References 42 publications

Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Factors predicting statin prescribing for primary prevention: a historical cohort study

The divided medical opinions of the statin debate updated

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