Cardiovascular disease, which includes strokes and heart attacks, is a leading cause of death in the UK and globally. Statins have been proven to be effective in reducing cardiovascular events and guidelines recommend the use of statins in those at risk of developing or with known cardiovascular disease. Despite this, previous studies suggest statins are under-prescribed and underused which leads to preventable heart attacks, strokes, and death. Previous studies have shown that certain patient groups such as ethnic minorities and older age groups are less likely to receive treatment. However, trends in statin prescribing and ongoing use in recent years are unclear. Additionally given the potential impact of the COVID-19 pandemic, it is also important to examine how statin use changed during the pandemic.
Our study will use anonymous GP and hospital records to determine the proportion of patients starting and continuing or stopping statins over time between 2009 and 2021. We will explore characteristics associated with statin use. We will also investigate the impact of the COVID-19 pandemic on statin use. This study will provide insight on whether statin guidelines are being followed and which patient groups are missing out on statins or stopping treatment. Our findings will inform strategies to improve statin uptake.
Statins are effective in the primary and secondary prevention of cardiovascular disease. Guidelines for the primary prevention of cardiovascular disease recommend prescribing statins in those with a 10-year cardiovascular risk score of 10% or higher from 2014 onwards or a 20% risk between 2005 and 2013. Secondary prevention of statins is recommended for all patients who have already had a cardiovascular event. However, previous studies suggest that these medicines are under-prescribed, which results in preventable cardiovascular outcomes and mortality. Previous studies also suggest there are inequalities in statin prescribing with certain patient groups such as ethnic minorities and older age groups less likely to receive treatment. Adherence to statins has been known to be poor thus limiting the potential for cardiovascular disease prevention. In more recent years, statin adherence and uptake may have been impacted by the COVID-19 pandemic which led to a dramatic reduction in access to health care services.
We will use data from the Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) to carry out a cohort study, examining trends and factors associated with statin prevalence, cardiovascular risk scoring and initiation of statins between 2009 and 2021. We will also examine trends and factors associated with statin persistence and cessation and we will estimate the number of cardiovascular events that can be prevented with optimal statin use. We will explore statin prevalence, initiation and persistence in the pre-pandemic and pandemic period. Our study will provide insight on the extent to which cardiovascular prevention guidelines for statins are being implemented, better understanding of any disparities in statin prescribing and inform strategies to improve statin uptake and future planning for pandemics.
1) Monthly proportion current statin users,
2) Monthly proportion of patients with a recorded cardiovascular risk score,
3) Monthly proportion of first ever statin prescription,
4) Time from initiation to discontinuation of statins.
5) Time from statin cessation to first subsequent statin prescription
6) Number of cardiovascular events prevented with optimal statin use
Krishnan Bhaskaran - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Rutendo Muzambi - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Emily Herrett - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Helen Strongman - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Tjeerd van Staa - Collaborator - University of Manchester