Skip to main content

Increasing the use of statins in people at low cardiovascular risk is difficult

Although statins reduce cardiovascular events even in people at low risk,[1] population benefits from their more widespread use will occur only if a sufficiently high proportion of people at lower cardiovascular risk (whether based on a formal risk assessment or on age alone) are prescribed statins.[2] Some of these issues were discussed in a commentary published in the BMJ.

Early evidence from the NHS Health Check programme suggests that it will be difficult to achieve high statin uptake in people at low cardiovascular risk. NHS Health Check is a population-wide primary prevention programme that was established in England by the Department of Health in 2009.[3] The programme represents a major investment in the prevention and early detection of cardiovascular disease.

In early results from the programme, prescription of statins in people at high cardiovascular risk (≥20%) increased from around 25% to only 45%.[4] The prescription of statins is likely to be substantially lower than 45% in people at lower (10-20%) cardiovascular risk. The relative contributions of physician and patient factors in the low uptake of statins in people assessed by the programme are still unclear. Preliminary findings from programme evaluations suggest that many people are reluctant to be prescribed long term statins because of the risk of side effects and the need for regular monitoring.[5] Statins may be clinically effective and cost effective, but it will be difficult to increase their use in people at low cardiovascular risk.

Referencesz
  1. Cholesterol Treatment Trialists’ (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet2012;380:581-90.MedlineWeb of Science
  2. Abramson JD, Rosenberg HG, Jewell N, Wright JM. Should people at low risk of cardiovascular disease take a statin? BMJ2013;347:f6123. (22 October.)FREE Full Text
  3. Dalton AR, Soljak M. The Nationwide systematic prevention of cardiovascular disease: the UK’s health check programme. J Ambul Care Manage2012;35:206-15.CrossRefMedline
  4. Dalton AR, Bottle A, Okoro C, Majeed A, Millett C. Uptake of the NHS Health Checks programme in a deprived, culturally diverse setting: cross-sectional study. J Public Health2011;33:422-9.CrossRefWeb of Science
  5. Majeed A. Population-based risk reduction for cardiovascular disease, diabetes, and kidney disease in England. SGIM Forum2011;34:9-13. https://skydrive.live.com/redir?resid=BFCC2CE4F2157051!281&authkey=!AGHtDs4ZEu7cLY8

Comments

Popular posts from this blog

Improving discharge planning in NHS hospitals

Factors that need to be considered in discharge planning that have been identified in previous projects include:

Ensuring that discharge arrangements are discussed with patients, family members and carers; and that they are given a copy of the discharge summary.Adequate coordination between the hospital, community health services, general practices, and the providers of social care services.There is a follow-up after discharge of patients at high risk of complications or readmission - either in person or by telephone - to ensure that the discharge arrangements are working well. Medicines reconciliation is carried out. This is the process of verifying patient medication lists at a point-of-care transition, such as hospital discharge, to identify which medications have been added, discontinued, or changed from pre-admission medication lists.Ensuring that any outstanding test results at discharge are obtained and passed on to primary care teams; and ensuring there are clear arrangements …

Can GPs issue private prescriptions to NHS patients?

The NHS prescription charge in England is currently £8.40 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.

In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the British Medical Association's General Practice Committee has obtained legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.

The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge. Fur…

What impact will Brexit have on the UK's life sciences sector?

On Thursday 3 November 2016, I spoke at a seminar at the Imperial College Business School on the topic of the impact of Brexit on the UK's life sciences sector (the NHS, universities, and pharmaceutical and biomedical companies). I emphasised the important role played in the life sciences sector by EU-trained professionals and the need to ensure that the UK continued to attract highly-qualified professionals to work, for example, in our National Health Service. I also discussed the need to increase spending on research and development to ensure that the UK remained a world leader in the biomedical industry. The other speakers at the seminar were Andrew Lansley (former Secretary of State for Health) and Richard Phillips (Director of Healthcare Policy at the Association of British Healthcare industries). The event was chaired by Andrew Brown. A copy of my talk can be viewed on Slideshare.