Statins and primary prevention: is all the evidence in?

Statin-prescribing trends for primary and secondary prevention of cardiovascular disease

OBJECTIVE

To determine the proportion of patients receiving statins for primary or secondary prevention of cardiovascular disease (CVD), as well as to describe lipid-screening trends.

DESIGN

Retrospective chart review using the Manitoba Primary Care Research Network repository.

SETTING

Manitoba.

PARTICIPANTS

A total of 149 262 patients.

MAIN OUTCOME MEASURES

Proportion of patients who were taking statins for primary or secondary prevention of cardiovascular disease (CVD), who did not have evidence of CVD recorded in their charts, and who underwent lipid screening; distribution of statins among age groups; and the proportion of patients eligible for lipid screening when the age cutoffs of the 2012 and 2016 Canadian Cardiovascular Society guidelines were applied.

RESULTS

Of the 149 262 patients, 139 025 (93%) did not have CVD recorded in their electronic medical records and made up the primary prevention group; of these 139 025 patients, 5955 (4%) were taking statins. Also in the primary prevention group, 14 814 (11%) patients were 75 years of age and older; of these patients, 1374 (9%) were taking statins. A total of 10 237 of the 149 262 (7%) patients had CVD recorded in their charts (secondary prevention group); 3013 (29%) of these patients were taking statins. When the 2016 Canadian Cardiovascular Society guidelines age cutoffs were applied, 56% of patients (83 119 of 149 262) were eligible for lipid screening, and 31% (26 024 of 83 119) of them had evidence of screening in the past 5 years. Of the total population of those aged 75 and older, 28% (5597 of 20 188) had undergone lipid screening. Of the total population taking statins, 28% (2481 of 8968) had undergone lipid testing while taking statins.

CONCLUSION

In Manitoba, less than 5% of the primary prevention population and less than 30% of the secondary prevention population had received repeat statin prescriptions from their primary care providers. This represents a possible practice gap that warrants future research, as statins offer considerable morbidity and mortality benefits in these patients.

The use of epidemiological measures to estimate the impact of primary prevention interventions on CHD, stroke and cancer outcomes: experiences from Herefordshire, UK

Background: CHD, stroke and cancers are the major causes of mortality in the UK and are responsible for significant amounts of morbidity and healthcare costs. This study examines the proportion of CHD, stroke and cancer owing to specific risk factors in Herefordshire, UK. It estimates the population impact of a number of interventions being implemented to reduce these risk factors, through the NHS Health Check program and the Herefordshire Health Improvement Plan. The present study also aims to demonstrate the value of epidemiological measures in providing evidence-based public health information in policy-making to aid decision makers when prioritizing investments and optimal use of resources.

Methods: The epidemiological measures–‘Population Attributable Risk’ and ‘Population Impact Measures’–were used to assess the impact of interventions to reduce the burden of CHD, stroke and cancer.

Results: Implementation of the NHS Health Check program will prevent 63 CHD events, 90 MI events and 125 stroke events, and one lung cancer over a period of 5 years. Reducing specific risk factors by 5% annually through the Health Improvement Plan will prevent 65 CHD events, 25 MI events, 140 stroke events, four lung cancer, one breast cancer and four colorectal cancer cases in Herefordshire if targets are met over a period of 5 years.

Conclusion: Physical inactivity and obesity are the major causes of CHD and stroke events (incidence and mortality) in Herefordshire. Their impact is greater than the combined effect of hypercholesterolemia and hypertension.

Epidemiological measures used in this study proved to be excellent tools in providing evidence-based public health information. Their use is strongly recommended to support prioritization of primary prevention interventions.