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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

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