Statin prescribing for primary prevention of cardiovascular disease: a cross-sectional, observational study

Abstract

Background: The updated (2014) National Institute for Health and Care Excellence (NICE) guideline lowered the recommended threshold for statin prescription from 20% to 10% 10-year cardiovascular disease (CVD) risk.

Aim: To determine the characteristics of patients prescribed statins for primary prevention according to their CVD risk.

Design and setting: Cross-sectional study in primary care settings in the three east London CCGs (Newham, City and Hackney, and Tower Hamlets).

Method: Data were extracted from electronic health records of 930 000 patients registered with 137 of 141 general practices for a year ending 1 April 2014.

Results: Of 341 099 patients aged 30-74 years, excluding those with CVD or diabetes, 22 393 were prescribed statins and had a 10-year CVD risk recorded. Of these, 9828 (43.9%) had a CVD risk ≥20%, 7121 (31.8%) had a CVD risk of 10-19%, and 5444 (24.3%) had a CVD risk <10%. Statins were prescribed to 9828/19 755 (49.7%) of those at ≥20% CVD risk, to 7121/37 111 (19.2%) of those with CVD risk 10-19%, and to 5444/146 676 (3.7%) of those with CVD risk <10%. Statin prescription below the 20% CVD risk threshold targeted individuals in the 10-19% risk band in association with hypertension, high serum cholesterol, positive family history, older age, and south Asian ethnicity.

Conclusion: This study confirms continuing undertreatment of patients at highest CVD risk (≥20%). GPs prescribed statins to only one-fifth of those in the 10-19% risk band usually in association with known major risk factors. Only 3.7% of individuals below 10% were prescribed statins.

Keywords: cardiovascular prevention; cardiovascular risk; primary care; statins.

Figure 1.

Flow chart to illustrate statin by CVD risk.