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The efficiency of cardiovascular risk assessment: do the right patients get statin treatment?
Tjeerd-Pieter van Staa1, Liam Smeeth, Edmond S-W Ng
1Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, , London, UK.
Insights
Statin prescribing for primary prevention is overused in low-risk patients and underused in high-risk patients, with significant practice variations. More trials are needed to optimize cardiovascular disease risk management.
Area of Science:
- Cardiology
- Public Health
- Pharmacoeconomics
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality.
- Statins are widely prescribed for primary prevention of CVD.
- Effective targeting of statin therapy is crucial for optimizing patient outcomes and resource allocation.
Purpose of the Study:
- To evaluate the effectiveness of targeting statin prescribing for primary prevention in individuals with high cardiovascular disease (CVD) risk.
- To analyze trends in statin prescribing patterns based on CVD risk stratification.
- To identify variations in statin prescribing practices across different healthcare settings.
Main Methods:
- Utilized two large UK cohort studies from the Clinical Practice Research Datalink, encompassing 3.8 million general population patients and 300,914 statin initiators aged 35-74 years.
- Analyzed statin prescribing rates stratified by calculated 10-year CVD risk.
- Observed 5-year CVD risks and assessed variability in prescribing patterns between general practices.
Main Results:
- Statin prescribing to high-risk patients (≥20% 10-year CVD risk) increased significantly from 7.0% pre-2007 to 30.4% post-2007.
- Prescribing to low-risk patients (<15% 10-year CVD risk) also rose, from 1.9% to 5.0%.
- Approximately half of patients initiating statins were classified as high-risk; observed 5-year CVD risks decreased over time (17.0% to 7.1%).
- Significant inter-practice variation was observed in statin prescribing for both high-risk (8.2%-61.5%) and low-risk (2.1%-29.1%) patients.
Conclusions:
- Substantial overuse of statins in low CVD risk populations and underuse in high CVD risk populations were identified, potentially affecting 600,000 and 850,000 UK patients, respectively, since 2007.
- Wide variations in statin prescribing for high-risk patients exist across general practices.
- Randomized controlled trials are needed to determine optimal strategies for statin therapy targeting and CVD risk management in primary prevention.
Objective:
To evaluate targeting of statin prescribing for primary prevention to those with high cardiovascular disease (CVD) risk.
Design:
Two cohort studies including the general population and initiators of statins aged 35-74 years.
Setting:
UK primary care records in the Clinical Practice Research Datalink.
Patients:
3.8 million general population patients and 300 914 statin users.
Intervention:
Statin prescribing.
Main Outcome Measures:
Statin prescribing by CVD risk; observed 5-year CVD risks; variability between practices.
Results:
Statin prescribing increased substantially over time to patients with high 10-year CVD risk (≥ 20%): 7.0% of these received a statin prior to 2007, and 30.4% in 2007 onwards. Prescribing to patients with low risk (<15%) also increased (from 1.9% to 5.0%). Only about half the patients initiating statin treatment were high risk according to CVD risk score. The 5-year CVD risks, as observed during statin treatment, reduced over calendar time (from 17.0% to 7.1%). There was a large variation between general practices in the percentage of high-risk patients prescribed a statin in 2007 onwards, ranging from 8.2% to 61.5%. For low-risk patients, these varied from 2.1% to 29.1%.
Conclusions:
There appeared to be substantive overuse in low CVD risk and underuse in high CVD risk (600 000 and 850 000 patients, respectively, in the UK since 2007). There is wide variation between practices in statin prescribing to patients at high CVD risk. There is a clear need for randomised trials for the best strategy to target statin treatment and manage CVD risk for primary prevention.
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