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I U Haq1, E J Wallis, P R Jackson
1Clinical Pharmacology and Therapeutics, Clinical Sciences Division, University of Sheffield, UK.
Insights
Targeting statin treatment for coronary heart disease (CHD) risk in hypertensive patients requires careful consideration. Current guidelines may lead to 27% of hypertensive patients receiving primary prevention statins.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Pharmacoeconomics
Background:
- Consensus is lacking on the optimal absolute coronary heart disease (CHD) risk threshold for initiating statin therapy.
- Hypertensive patients represent a key population for cardiovascular risk management.
Purpose of the Study:
- To evaluate the impact of different statin treatment policies on hypertensive patients in the UK.
- To determine the proportion of hypertensive patients eligible for statin therapy under various risk thresholds for primary and secondary prevention.
Main Methods:
- Utilized data from the Health Survey for England (1993) on treated hypertensive patients aged 35-69.
- Calculated statin eligibility for secondary prevention based on existing atherosclerotic cardiovascular disease.
- Estimated CHD risk using the Framingham equation for primary prevention and applied thresholds of 4.5%, 3.0%, and 1.5% annual risk.
Main Results:
- 21% of treated hypertensive patients qualified for statin therapy for secondary prevention.
- Primary prevention statin eligibility varied significantly with risk thresholds: 0.6% at >4.5% annual risk (NNT=13), 5.5% at 3.0% annual risk (NNT=20), and 28.5% at 1.5% annual risk (NNT=40).
Conclusions:
- Secondary prevention of CHD is the priority for statin initiation in hypertensive patients.
- Guideline development for primary prevention must consider Number Needed to Treat (NNT), treatment proportions, cost-effectiveness, and total treatment costs.
- Current British guidelines may result in 27% of hypertensive patients receiving statins, including 5.5% for primary prevention.
Background:
There is broad agreement that statin treatment should be targeted at absolute coronary heart disease (CHD) risk but no consensus on the level of risk to target. We have examined the implications of adopting three different treatment policies for the management of hypertensive patients in the UK using data from treated hypertensives aged 35-69 years included in the Health Survey for England (1993).
Methods:
We calculated the proportion of hypertensive patients with existing atherosclerotic cardiovascular disease requiring statin treatment for secondary prevention of CHD. For those without atherosclerotic cardiovascular disease (primary prevention), we estimated CHD risk from the Framingham equation and examined the proportion with CHD risk exceeding thresholds of 4.5, 3 and 1.5% per year.
Results:
Twenty-one percent of treated hypertensives would require statin treatment for secondary prevention of CHD. When the CHD event threshold for statin treatment was set at > or =4.5% per year [equivalent to a number needed to treat (NNT) in 5 years of 13] a further 0.6% of hypertensive patients were identified for treatment; at a threshold of 3.0% per year (NNT = 20) 5.5% of patients were identified for primary prevention; and at a threshold of 1.5% per year (NNT = 40) 28.5% of patients were identified for primary prevention.
Conclusions:
Those needing secondary prevention are first priority for statins and 21% of hypertensive patients will require treatment Formulation of guidelines for primary prevention should take into account the NNT; the proportion of patients targeted for treatment; the cost-effectiveness and the total cost of treatment. Current British guidance will entail treating an additional 5.5% of hypertensive patients for primary prevention and therefore 27% of hypertensive patients.