title: The efficiency of cardiovascular risk assessment: do the right patients get statin treatment?
abstract: OBJECTIVE
  To evaluate targeting of statin prescribing for primary prevention to those with high cardiovascular disease (CVD) risk.
  
  
  METHODS
  Two cohort studies including the general population and initiators of statins aged 35-74 years.
  
  
  METHODS
  UK primary care records in the Clinical Practice Research Datalink.
  
  
  METHODS
  3.8 million general population patients and 300 914 statin users.
  
  
  METHODS
  Statin prescribing.
  
  
  METHODS
  Statin prescribing by CVD risk; observed 5-year CVD risks; variability between practices.
  
  
  RESULTS
  Statin prescribing increased substantially over time to patients with high 10-year CVD risk (≥ 20%): 7.0% of these received a statin prior to 2007, and 30.4% in 2007 onwards. Prescribing to patients with low risk (<15%) also increased (from 1.9% to 5.0%). Only about half the patients initiating statin treatment were high risk according to CVD risk score. The 5-year CVD risks, as observed during statin treatment, reduced over calendar time (from 17.0% to 7.1%). There was a large variation between general practices in the percentage of high-risk patients prescribed a statin in 2007 onwards, ranging from 8.2% to 61.5%. For low-risk patients, these varied from 2.1% to 29.1%.
  
  
  CONCLUSIONS
  There appeared to be substantive overuse in low CVD risk and underuse in high CVD risk (600 000 and 850 000 patients, respectively, in the UK since 2007). There is wide variation between practices in statin prescribing to patients at high CVD risk. There is a clear need for randomised trials for the best strategy to target statin treatment and manage CVD risk for primary prevention.
authors.affiliation: Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, , London, UK.
authors.forename: Tjeerd-Pieter
authors.initials: TP
authors.lastname: van Staa
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.forename: Edmond S-W
authors.initials: ES
authors.lastname: Ng
authors.forename: Ben
authors.initials: B
authors.lastname: Goldacre
authors.forename: Martin
authors.initials: M
authors.lastname: Gulliford
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003661:Decision Support Techniques; D011307:Drug Prescriptions; D004363:Drug Utilization; D017723:Drug Utilization Review; D050171:Dyslipidemias / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends; D011320:Primary Health Care; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors