Statin prescribing for primary prevention of cardiovascular disease: a cross-sectional, observational study

Abstract

BackgroundThe updated (2014) National Institute for Health and Care Excellence (NICE) guideline lowered the recommended threshold for statin prescription from 20% to 10% 10-year cardiovascular disease (CVD) risk. AimTo determine the characteristics of patients prescribed statins for primary prevention according to their CVD risk. Design and settingCross-sectional study in primary care settings in the three east London CCGs (Newham, City and Hackney, and Tower Hamlets). MethodData were extracted from electronic health records of 930 000 patients registered with 137 of 141 general practices for a year ending 1 April 2014. ResultsOf 341 099 patients aged 30-74 years, excluding those with CVD or diabetes, 22 393 were prescribed statins and had a 10-year CVD risk recorded. Of these, 9828 (43.9%) had a CVD risk ≥20%, 7121 (31.8%) had a CVD risk of 10-19%, and 5444 (24.3%) had a CVD risk <10%. Statins were prescribed to 9828/19 755 (49.7%) of those at ≥20% CVD risk, to 7121/37 111 (19.2%) of those with CVD risk 10-19%, and to 5444/146 676 (3.7%) of those with CVD risk <10%. Statin prescription below the 20% CVD risk threshold targeted individuals in the 10-19% risk band in association with hypertension, high serum cholesterol, positive family history, older age, and south Asian ethnicity. ConclusionThis study confirms continuing undertreatment of patients at highest CVD risk (≥20%). GPs prescribed statins to only one-fifth of those in the 10-19% risk band usually in association with known major risk factors. Only 3.7% of individuals below 10% were prescribed statins.

Statin initiations and QRISK2 scoring in UK general practice: a THIN database study

“…Of these, 151 788 had a recorded CVD risk score since 2012 (10.67%) and 217 860 were initiated on a statin (15.31%). Among patients initiated on a statin after 2012, 27.1% had a documented QRISK2 score: 2.7% of low-risk, 13…”

“…Relationship between QRISK2 scoring and statin initiation. QRISK2 scores were categorised into low (<10%), intermediate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19).9%) and high (>20%) 10-year CVD risk. In each category, the proportion of patients initiated on statins following QRISK2 scoring was established based on the patient's latest record.…”

“…9,10 The use of CVD risk scoring should result in more targeted prescribing, but there is evidence both of undertreatment of high-risk patients and overtreatment of low-risk patients. [11][12][13][14][15] This may be because risk scores are not consistently used by clinicians 16 or because clinical information not incorporated into the risk scores is being taken into account.…”

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

“…[18][19][20] In the context of primary prevention, there is evidence both of undertreatment of high-risk patients (above the treatment threshold) and inappropriate treatment of low-risk patients (below the treatment threshold). [21][22][23][24] Moreover, patients with the highest absolute CVD risk are at greatest risk of being undertreated. 25 One reason for this is that risk scores may not be consistently used by clinicians to guide decision-making.…”

Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

“…Although controlled clinical studies proved the efficacy of primary prevention with statins in reducing all-cause mortality and the risk of primary cardiovascular events [30,31], other observational studies also reported the undertreatment of patients eligible for preventive lipid-lowering therapy [27,[32][33][34][35][36]. The rates of undertreatment with antihypertensive agents are lower [36][37][38], which can be explained by well-established evidence on efficacy, good safety profiles and the low cost of these drugs [37].…”