Statins are not always prescribed to the patients who will benefit most

October 26, 2017, University of Birmingham
Credit: University of Birmingham

A study by the University of Birmingham has found that statins are not always prescribed to patients who will benefit the most from them.

This research by the team from the Institute of Applied Health Research examined the clinical records of 1.4 million patients who did not have existing cardiovascular disease and who were not taking, or had not been offered, in the past. These patients were suitable for a cardiovascular diseases (CVD) risk assessment to guide clinicians in deciding who should be offered a statin for the primary prevention of CVD.

The risk assessment results in a QRISK2 score - a prediction algorithm for CVD that uses traditional risk factors (age, systolic blood pressure, smoking status and ratio of total serum cholesterol to high-density lipoprotein cholesterol) together with body mass index, ethnicity, measures of deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial fibrillation, diabetes mellitus, and antihypertensive treatment.

The study found that the majority of patients (over 90 percent) who had a QRISK2 score coded between 2012 and 2015 did not go on to have a statin prescribed.

This was in part due to the fact that around 60 percent of these patients fell into the 'low risk' category and therefore, according to NICE guidelines, should not be prescribed statins.

However, despite the NICE guidelines, there was still a small but significant proportion of this group being prescribed statins. Initiations in this group accounted for one in six of all new statin initiations to patients with a coded risk score.

About a third of patients who fell into the highest risk category were initiated on statins. Those who were not initiated on statins may have been offered treatment but declined; or, potentially, they weren't offered a statin.

Dr Samuel Finnikin said: "The decision to start a statin is a difficult one for many reasons. People should be helped to make this decision by having a discussion with their healthcare professional about the risks and benefits of treatment informed by an estimate of the personal level of risk.

"Only by undertaking a formal risk assessment can the clinician know who to offer a statin to, and the patient understand the degree of benefit they can expect from the medication. Our research suggests that the risk assessment is perhaps not always being routinely undertaken and documented.

"An estimated CVD risk score is an essential part of the shared decision to initiate statins to reduce the risk of heart disease and stroke. Without it, we run the risk of over treating patients who are unlikely to benefit, and potentially initiate treatment without patients being fully aware of the benefits to them".

Since 2012, when the QRISK2 score was introduced, 72.9 percent of statin initiations were to patients who did not have a documented QRISK2 score.

These patients may have had a risk assessment that wasn't documented, or had a risk score calculated with a different tool. However, these data suggest a significant number of patients are being started on statins without having a formal CVD risk assessment done.

Without a risk assessment, clinicians can't be sure that they have identified patients who are most likely to benefit from statins, and patients can't be provided with accurate information about the benefits of taking a statin so the decision can't be made based on the best possible information. Younger patients, who are more likely to have a low , are more likely to be started on a statin without a risk assessment.

Explore further: Statin use linked to heightened type 2 diabetes risk in susceptible individuals

More information: Samuel Finnikin et al. Statin initiations and QRISK2 scoring in UK general practice: a THIN database study, British Journal of General Practice (2017). DOI: 10.3399/bjgp17X693485

Related Stories

Statin use linked to heightened type 2 diabetes risk in susceptible individuals

October 23, 2017
Long term use of statins to lower blood fats and stave off cardiovascular disease is associated with a 30 per cent heightened risk of developing type 2 diabetes in susceptible individuals, suggests a large study published ...

Quitting statins after stroke may raise risk of another stroke

August 2, 2017
Stroke patients who stopped taking statin drugs three to six months after a first ischemic stroke, the type caused by narrowed arteries, had a higher risk of a having another stroke within a year, according to new research ...

Researchers identify strategies to optimize statin treatment for muscle symptoms

August 28, 2017
Statins are highly effective for preventing heart attacks by reducing low-density lipoprotein or "bad" cholesterol. However, 10 to 20 percent of patients taking statins report muscle-related symptoms including aches, pains ...

Calcium in arteries influences heart attack risk

August 8, 2017
Patients without calcium buildup in the coronary arteries had significantly lower risk of future heart attack or stroke despite other high risk factors such as diabetes, high blood pressure, or bad cholesterol levels, new ...

Meta-analysis: statins cut risk of advanced colorectal adenoma

November 30, 2016
(HealthDay)—Statins seem not to be associated with the risk of colorectal adenoma, but are associated with reduced risk of advanced adenoma, according to a review and meta-analysis published online Nov. 23 in the Journal ...

No need to avoid statins in hep C compensated cirrhosis

February 10, 2016
(HealthDay)—Statin use is associated with decreased risk of cirrhosis decompensation and death in patients with hepatitis C virus (HCV)-related compensated cirrhosis, according to research published in the February issue ...

Recommended for you

New cellular pathway helps explain how inflammation leads to artery disease

June 21, 2018
Investigators have identified a new cellular pathway that may help explain how arterial inflammation develops into atherosclerosis—deposits of cholesterol, fats and other substances that create plaque, clog arteries and ...

'Smart stent' detects narrowing of arteries

June 19, 2018
For every three individuals who have had a stent implanted to keep clogged arteries open and prevent a heart attack, at least one will experience restenosis—the renewed narrowing of the artery due to plaque buildup or scarring—which ...

Marriage may protect against heart disease / stroke and associated risk of death

June 18, 2018
Marriage may protect against the development of heart disease/stroke as well as influencing who is more likely to die of it, suggests a pooled analysis of the available data, published online in the journal Heart.

Deaths from cardiac arrest are misclassified, overestimated

June 18, 2018
Forty percent of deaths attributed to cardiac arrest are not sudden or unexpected, and nearly half of the remainder are not arrhythmic—the only situation in which CPR and defibrillators are effective—according to an analysis ...

Tick-borne meat sensitivity linked to heart disease

June 15, 2018
University of Virginia School of Medicine researchers have linked sensitivity to an allergen in red meat—a sensitivity spread by tick bites—with a buildup of fatty plaque in the arteries of the heart. This buildup may ...

Tobacco aside, e-cigarette flavorings may harm blood vessels

June 14, 2018
Flavor additives used in electronic cigarettes and related tobacco products could impair blood vessel function and may be an early indicator of heart damage, according to new laboratory research in Arteriosclerosis, Thrombosis ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.