Changes over time in the monitoring of cardiovascular risk in primary care, and the use of statins for the primary and secondary prevention of cardiovascular disease.

Application Number
17_008
Lay Summary

There has been much interest, both in scientific and general media, in the practice of prescribing statin medication to prevent cardiovascular diseases such as heart attacks and strokes. UK guidelines currently recommend that patients are offered a statin if: (i) their estimated risk of having a cardiovascular disease event like a heart attack over the next 10 years is 10% or more (before 2014 this threshold was 20%); or (ii) if they have previously had a heart or circulatory disease diagnosis. Using data from the Clinical Practice Research Datalink database, which collects information from participating general practices in England and Wales, this study aims to describe trends in the recording of estimated cardiovascular risk, and in the prescription of statins to these two groups of eligible patients over time, including changes in trends by age group, sex and socioeconomic status. Among patients starting a statin, we will also examine whether people appear to consistently take the pills as prescribed, how often people report muscle symptoms, and how long people stay on the therapy. These analyses will provide an insight into whether clinical guidelines are routinely followed, whether all groups of patients are being monitored and offered statin treatment equally, and the extent to which people who start a statin remain on their drug as intended.

Technical Summary

There has recently been much interest in the practice of prescribing statins to prevent cardiovascular disease. The National Institute for Health and Care Excellence currently recommends the prescription of stations for: (i) primary prevention of cardiovascular disease, following a ten year cardiovascular risk score of 10% (prior to 2014 this threshold was 20%); and (ii) secondary prevention following a cardiovascular event. Using primary care data from the Clinical Practice Research Datalink, we will first describe trends in cardiovascular risk monitoring among people with no prior cardiovascular disease. Among people eligible to start a statin, logistic regression will be used to look at calendar time changes in, and other factors associated with, initiating a statin. Patterns of statin adherence will be described, and discontinuation will also be examined using time-to-event methods. This study will provide insight into how well routine practice is aligned with clinical guidelines, and help generate hypotheses about which patient groups are not initiating, or are discontinuing, statin use.

Health Outcomes to be Measured

Statin prescription; Cardiovascular risk score record.

Collaborators

Krishnan Bhaskaran - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sarah Gadd - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Anthony Matthews - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Emily Herrett - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )

Linkages

HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation