NICE guidance published in 2014 recommends ‘high-intensity’ statins to reduce LDL-cholesterol by at least 40%, for both primary and secondary prevention. The high-intensity treatment options available in the UK are atorvastatin >20mg, simvastatin 80mg, and rosuvastatin >10mg.
However, an analysis of prescribing data from general practices in England shows 45% of statins were prescribed below the recommended 40% LDL-lowering threshold in 2019. The proportion had decreased from 80% in 2011/2012.
The analysis, published in BJGP, used OpenPrescribing data for all 8142 standard NHS general practices from August 2010 to March 2019. OpenPrescribing.net is an online service that provides free access to monthly prescription data and charts describing treatment choices at GP practices in England.
When the researchers used an alternative 'pragmatic' LDL-cholesterol reduction threshold of 37%, to account for patients not being reviewed/switched if they were already on statins very close to the NICE threshold, the proportion of low- or medium-intensity statin prescribing was 18% in 2019, down from a peak of 30% in 2013.
The trends did not change significantly for either threshold after the publication of NICE guidance in 2014.
Wide variation was found between practices, with interdecile ranges of 20–85% and 10%–30% for the NICE threshold and the pragmatic threshold, respectively, in 2018.
The authors estimate that are 10 avoidable cardiovascular events every 10 years for every 1000 patients inappropriately given a lower-potency statin. However, they highlight that some practices showed rapid positive change in prescribing, which they say shows there is scope to achieve wider guideline compliance.
Prescribing of high potency statins (or any other medicines) at any individual NHS general practice in England can be viewed at OpenPrescribing.net.