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Cardiovascular risk in hypertension: implications of the Sheffield Table for lipid-lowering strategy
S Hasnain1, J Webster, J S McLay
1Department of Medicine and Therapeutics, University of Aberdeen, Scotland, UK.
Insights
Statin therapy use for preventing heart disease is low, with many eligible patients not receiving treatment. This study highlights a gap between recommended care and actual practice in cardiovascular clinics.
Area of Science:
- Cardiology
- Public Health
- Evidence-Based Medicine
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Statin therapy is a cornerstone in both primary and secondary prevention of CVD.
- Guidelines recommend specific criteria for initiating statin therapy based on risk assessment.
Purpose of the Study:
- To assess the current utilization of statin therapy for primary and secondary prevention of coronary heart disease (CHD).
- To evaluate the impact of implementing the Sheffield Table criteria on statin prescription for primary prevention.
- To identify discrepancies between evidence-based guidelines and clinical practice in a specialized cardiovascular risk clinic.
Main Methods:
- A prospective audit of patient data was conducted at the Aberdeen Hypertension Clinic.
- The study reviewed the current use of lipid-lowering therapy.
- The impact of applying the Sheffield Table and Scandinavian Simvastatin Study criteria on statin use was analyzed for at-risk patients.
Main Results:
- Out of 1500 patients, 416 had existing atherosclerotic cardiovascular disease (CVD).
- Only 11.2% of eligible patients received lipid-lowering treatment for secondary prevention.
- For primary prevention, 9.4% were eligible via the Sheffield Table, but only 6.5% were receiving statin therapy.
Conclusions:
- A significant gap exists between recommended and actual statin therapy delivery in a consultant-led cardiovascular prevention clinic.
- Underutilization of statin therapy was observed for both secondary and primary prevention.
- These findings underscore the need to improve adherence to evidence-based guidelines for cardiovascular risk management.
Objective:
To determine the actual use of 'statin' therapy for primary and secondary prevention and the potential effect of using the Sheffield Table for primary prevention of coronary heart disease upon 'statin' use in a consultant-run Hypertension and Cardiovascular Risk Clinic.
Design:
Prospective audit of the current use of cholesterol-lowering therapy and the effect of implementing the criteria used in the Sheffield Table and the Scandinavian Simvastatin Study for cholesterol lowering in 'at risk' patients upon statin use in a consultant-led cardiovascular risk clinic.
Setting:
The Aberdeen Hypertension Clinic.
Results:
A total of 1500 patients were reviewed of which 416 (27.7%) had experienced at least one clinical manifestation of atherosclerotic cardiovascular disease (CVD) and 392 (94%) of these had a total cholesterol measured of whom 298 (76%) had a total cholesterol >5.5 mmol/l. Only 11.2% of eligible patients were actually receiving lipid-lowering treatment for secondary prevention. A total of 1084 patients with no prior cardiovascular disease were identified, 97 (8.9%) were excluded because of age. Using the Sheffield Table, 92 (9.4%) of these patients were eligible for statin therapy and only six of the 92 patients were actually receiving treatment.
Conclusions:
The results of this study reveal that even in a consultant-led cardiovascular prevention clinic there is a significant discrepancy between optimal evidence-based management and the actual delivery of clinical care. Seventy-two per cent and 9.3% of patients attending the clinic were eligible for statin treatment for secondary and primary prevention, respectively. However, only 11.2% of patients suitable for secondary prevention and 6.5% of patients suitable for primary prevention were actually receiving appropriate lipid-lowering therapy. Considering the proven benefit of this form of medical intervention the results of this study are of real importance to practising clinicians and patients alike.