Infographic: Statins not prescribed in two thirds of high-risk patients

Prescribing of statins in high-risk patients has decreased despite the lowering of the recommended initiation threshold, whilst patients in low-risk categories are being overtreated, a new study reveals.

Researchers at the University of Birmingham have shown that statins are usually prescribed without recording of the QRISK2 cardiovascular risk assessment score recommended by NICE. Even when a score is documented, the majority of high-risk patients do not receive statins.

Samuel Finnikin and colleagues analysed GP prescribing data for 1.4 million adults from 248 practices across the UK between January 2000 and December 2015, to examine the relationship between cardiovascular risk scoring and the initiation of statins in primary care.

Although the researchers found there was a steady increase in the recording of QRISK2 score since 2012, when the tool became available, 72.9% of patients initiated on statins did not have a score recorded. Of those who did, only 35% of patients in the high-risk category were put on a statin. Conversely, one in six statin initiations were in patients in the low-risk category, indicating significant overtreatment in this group. 

The researchers also investigated the effect on statin prescribing of the 2014 NICE guidance on lipid modification, which halved the recommended threshold for statin initiation to include patients with a 10% risk of developing cardiovascular disease over 10 years. 

When comparing data in the 18 months before and after publication of the guidance, the study found that the rate of statin initiation among patients in the intermediate-risk category increased while the rate among high-risk patients continued to decrease.

‘It is not possible to establish whether those patients who were above the threshold to be prescribed a statin did not receive treatment because they were not offered it or because they declined an offer,’ noted the researchers.  

Shared decision

Professor Helen Stokes-Lampard, chair of the RCGP, called the study 'interesting' but said it 'simplifies the true situation' because it did not consider individual patient circumstances that influence statin prescribing, such as patient preference and comorbidities.

However, she said the study 'emphasises the importance of calculating an accurate risk score which can then help healthcare professionals have an honest discussion with their patients about the benefits and risks which are unique to them.'

'As with any drug, taking statin medication has potential side-effects, and taking any medication long-term is a substantial undertaking for patients who need to be monitored by healthcare professionals. Many don’t want to take statins once they have learned all the facts – and GPs will respect patient choice,’ she added.

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