Posted on September 8, 2015
Observational cross sectional study (Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)) in 930 000 patients (30 – 74 yrs; no CVD – no DM) of 137 London based general practices during 1 year ending 1 April 2014.
Evaluation of the new 2014 NICE guideline on the impact of statin treatment in London GP’s. Threshold for initiating statin treatment was lowered from 20% to 10% 10 year cardiovascular r(CVD) risk This study evaluated the risk profile of 341 000 patients without CVD or diabetes who were using statins. The three risk categories evaluated where CVD risk of < 10%, 10%-19% and ≥ 20%. Treatment with statins was observed in respectively 3.7%; 19.2% and 43.9%. The group in the intermediate risk category received treatment because of hypertension, high serum cholesterol, positive family history, older age, and south Asian ethnicity.
Statins were not prescribed in 80% of those at moderate risk (10%-19%), and in the highest CVD risk category (≥ 20%) half of the patients were not on statins. The fear of overtreatment in the low risk category was not observed. Only a modest 3.7% in that category were taking statins.
Strengths – Weakness
Recent study of London region GP practices with a better than average implementation of the NHS Health Check Program. Good risk factor recording was available for those on statins but limited data on was available for the individuals not on statins, this constituted almost 40% of the eligible population >35yrs. An underestimation of risk associated with extreme obesity, pre-diabetic states, chronic kidney disease, or other aspects such as heavy alcohol consumption or very sedentary lifestyles is likely and has not been evaluated in this study
“The problem is not so much overtreatment at lower risk levels, as under treatment for those at highest risk”
This study highlights the dilemma of providing optimal care based on guidelines and the prevalence of large numbers of individuals that would be eligible for statin treatment. Despite the reduction in costs, due to end of patents of most statins available today, in the UK almost 30-50% of the populations would fulfill the recent NICE criteria for statin treatment with a 10 year risk ≥ 10%. This is not realistically feasible nor political acceptable. More emphasis on finding the ones at high risk, where roughly 70% – 50% are missing the protection of high intensity, high dose statins, should be a priority.
Statin prescribing for primary prevention of cardiovascular disease: a cross-sectional, observational study. Homer K, Boomla K, Hull S et al. Br J Gen Pract 2015; 65:e538-544 PMID: 26212850.