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Applying the Sheffield tables to data from general practice
J Muir1, A Fuller, T Lancaster
1General Practice Research Group, University of Oxford.
Insights
Statin drugs lower cholesterol and reduce coronary event risk. The Sheffield tables identify high-risk individuals, with 3% of men and 0.05% of women exceeding the threshold, primarily older smokers.
Area of Science:
- Cardiology
- Preventive Medicine
- Pharmacology
Background:
- Cardiovascular disease remains a leading cause of mortality globally.
- Statins are a widely prescribed class of drugs for lowering cholesterol.
- Current guidelines advocate for risk-based statin therapy initiation.
Purpose of the Study:
- To evaluate the application of the Sheffield tables in a general practice cohort.
- To identify the proportion of individuals exceeding the 3% 10-year coronary event risk threshold.
- To assess the demographic characteristics of individuals recommended for statin therapy.
Main Methods:
- Retrospective analysis of a general practice cohort aged 35-68 years.
- Application of the Sheffield tables to estimate the absolute risk of a first coronary event.
- Stratification of results by age, sex, and smoking status.
Main Results:
- 3% of men and 0.05% of women were identified as candidates for statin therapy based on the Sheffield tables.
- Individuals aged over 50 who smoked constituted 85% of those recommended for treatment.
- Smoking cessation was associated with a significant reduction in coronary event risk, potentially bringing most smokers below the treatment threshold.
Conclusions:
- The Sheffield tables identify a small but significant proportion of individuals eligible for statin therapy in primary care.
- Smoking is a major modifiable risk factor driving statin recommendations in older adults.
- Smoking cessation interventions could substantially decrease the number of individuals requiring pharmacological cholesterol management.
Abstract:
Lowering cholesterol with drugs of the statin class reduces the risk of a coronary event. Recent guidelines recommend use of the 'Sheffield tables' to detect individuals who might be offered drug treatment in whom the annual absolute risk of a first coronary event is > or = 3%. Using these tables in a general practice cohort aged 35-68 years, we found that 3% of men and 0.05% of women were above the treatment threshold. Smokers aged over 50 accounted for 85% of people recommended for statin therapy. Almost all smokers would fall below the treatment threshold if they quit smoking.