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A cross-sectional study evaluating cardiovascular risk and statin prescribing in the Canadian Primary Care Sentinel
Ian S Johnston1,2, Brendan Miles3, Boglarka Soos3
1University of Calgary, Calgary, Canada. ian.johnston2@ucalgary.ca.
Insights
High cardiovascular disease (CVD) risk in Canada is linked to older age, male sex, comorbidities, and lower socioeconomic status. Lower socioeconomic groups with high CVD risk may not receive guideline-recommended statin treatment.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiovascular disease (CVD) is a leading cause of death and illness in Canada.
- Effective CVD risk assessment and management are crucial for reducing disease burden.
- Socioeconomic factors significantly influence CVD risk and treatment, yet are underreported.
Purpose of the Study:
- To estimate cardiovascular risk among Canadian primary care patients.
- To evaluate statin prescribing patterns based on CVD risk and socioeconomic status (SES).
- To assess adherence to clinical practice guidelines for CVD treatment.
Main Methods:
- Cross-sectional observational study using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database.
- Included 324,526 patients aged 35-75 years (2012-2016).
- Assessed CVD risk categories and socioeconomic deprivation quintiles; analyzed statin prescription concordance with guidelines using logistic regression.
Main Results:
- 36% of patients were categorized as high CVD risk, predominantly older males with comorbidities.
- High CVD risk was disproportionately concentrated in the most deprived socioeconomic quintile (OR 1.4).
- 48% of high-risk patients received statin prescriptions; lower SES groups showed guideline deviations in treatment.
Conclusions:
- High CVD risk patients are more likely to be male, older, have comorbidities, and belong to deprived socioeconomic groups.
- Patients facing socioeconomic challenges may receive CVD treatments less aligned with clinical guidelines.
- Addressing socioeconomic disparities is vital for equitable CVD risk management and treatment.
Background:
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in Canada. Assessment and management of CVD risk is essential in reducing disease burden. This includes both clinical risk factors and socioeconomic factors, though few studies report on socioeconomic status in relation to CVD risk and treatment. The primary objective of this study was to estimate the cardiovascular risk of patients attending primary care practices across Canada; secondly, to evaluate concordance with care indicators suggested by current clinical practice guidelines for statin prescribing according to patients' cardiovascular risk and socioeconomic status.
Methods:
This cross-sectional observational study used the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, which is comprised of clinical data from primary care electronic medical records. Patients aged 35-75y with at least one visit to their primary care provider between 2012 and 2016 were included. Patients were assigned to a CVD risk category (high, medium, low) and a deprivation quintile was calculated for those with full postal code available. Descriptive analyses were used to determine the proportion of patients in each risk category. Logistic regression was used to evaluate the consistency of statin prescribing according to national clinical guidelines by risk category and deprivation quintile.
Results:
A total of 324,526 patients were included. Of those, 116,947 (36%) of patients were assigned to a high CVD risk category, primarily older adults, males, and those with co-morbidities. There were statistically significant differences between least (quintile 1) and most (quintile 5) deprived socioeconomic quintiles, with those at high CVD risk disproportionately in Q5 (odds ratio 1.4). Overall, 48% of high-risk patients had at least one statin prescription in their record. Patients in the lower socioeconomic groups had a higher risk of statin treatment which deviated from clinical guidelines.
Conclusions:
Primary care patients who are at high CVD risk are more often male, older, have more co-morbidities and be assigned to more deprived SES quintiles, compared to those at low CVD risk. Additionally, patients who experience more challenging socioeconomic situations may be less likely to receive CVD treatment that is consistent with care guidelines.
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