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

Area of Science:

• Cardiology
• Public Health
• Health Informatics

Background:

• Statin initiation for primary cardiovascular disease (CVD) prevention should align with estimated CVD risk.
• Current statin prescribing practices are suboptimal, indicating a gap between guidelines and clinical application.

Purpose of the Study:

• To investigate factors influencing statin prescribing decisions.
• To compare statin prescribing patterns when clinicians code estimated CVD risk (QRISK2) versus when they do not.

Main Methods:

• A historical cohort study analyzed UK primary care records (IQVIA Medical Research Data) from 2012-2016.
• Included statin-naive patients without prior CVD undergoing lipid testing.
• QRISK2 scores were extracted if coded; otherwise, calculated post hoc. Statin initiation within 60 days of lipid testing was the primary outcome.

Main Results:

• Only 21.4% of lipid test entries had a coded QRISK2 score.
• Statin initiation was higher when QRISK2 was coded (6.6%) compared to uncoded (4.1%).
• Prescribing aligned with guidelines in 85.0% of coded QRISK2 cases versus 44.2% of uncoded cases.

Conclusions:

• Coded QRISK2 scores lead to statin prescribing more consistent with National Institute for Health and Care Excellence guidelines.
• When QRISK2 is not coded, total cholesterol becomes the primary driver for statin initiation.
• Routine use of CVD risk estimation tools like QRISK2 is crucial for optimizing statin prescribing and patient benefit.