General Practitioners (GPs) are encouraged to do all they can to reduce the risk of heart attacks and strokes in their patients through prescribing medication, such as statins. Evidence of the benefits of these medications often comes from people who are not like typical patients. For example, they generally only have one condition, and are relatively young and rich compared to the general population. However, GPs are increasingly looking after an ageing population with multiple health problems. Little is known about how effective risk-reducing drugs are in preventing heart attacks and strokes in patients with several health problems.
We will investigate whether risk-reducing medication prevent heart attacks and strokes in patients with two or more health problems.
This work has the potential to benefit a large number of patients. Patients, with multiple health problems may be more likely to have a heart attack or stroke and therefore gain more from taking preventative medication, compared to patients with fewer health problems. Yet, GPs may be less likely to prescribe these preventative drugs, as patients with several conditions may already be taking an extensive range of medication. This study will help us understand the benefits of prescribing preventative drugs in this increasingly growing population.
GPs are encouraged to aggressively reduce cardiovascular risk in their patients through prescribing primary and secondary preventative therapeutic treatments. Evidence of the benefits from such risk-reduction strategies from RCTs is strong. However, RCTs are typically conducted among relatively young, affluent participants, who are comparatively healthy with under-representation of other health conditions. It is not clear whether treatment effects demonstrated in RCTs generalise to a multi-morbid population.
The study will use data from adult patients who have been diagnosed with 2 or more conditions and are at risk of CVD from between 2004 and 2014. The primary outcomes will be an incident CVD event or death, and any death as a secondary outcome. Our key exposure with be a prescription of a CVD preventative medication, including statins, anti-hypertensives, dual antiplatelet therapy and anti-diabetic agents. Survival analysis will be used to compare the CVD event/mortality rates between patients prescribed CVD preventative medication, with those not. Adjustments will be made for GP practice, age, sex, socio-economic status, multi-morbidities, other medication, BMI and smoking status.
Findings from this study have the potential to improve the treatment and management of a growing proportion of the general population, potentially preventing further morbidity in a high risk population.
Rachel Denholm - Chief Investigator - University of Bristol
Rachel Denholm - Corresponding Applicant - University of Bristol
John Macleod - Collaborator - University of Bristol
Neil Davies - Collaborator - University of Bristol
Rachael Hughes - Collaborator - University of Bristol
Richard Morris - Collaborator - University of Bristol
Rupert Payne - Collaborator - University of Bristol
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation