title: Variations in statin prescribing for primary cardiovascular disease prevention: cross-sectional analysis.
abstract: BACKGROUND
  Statins are an important intervention for primary and secondary cardiovascular disease (CVD) prevention. We aimed to establish the variation in primary preventive treatment for CVD with statins in the English population.
  
  
  METHODS
  Cross sectional analyses of 6155 English primary care practices with 40,017,963 patients in 2006/7. Linear regression was used to model prescribing rates of statins for primary CVD prevention as a function of IMD (index of multiple deprivation) quintile, proportion of population from an ethnic minority, and age over 65 years. Defined Daily Doses (DDD) were used to calculate the numbers of patients receiving a statin. Statin prescriptions were allocated to primary and secondary prevention based on the prevalence of CVD and stroke.
  
  
  RESULTS
  We estimated that 10.5% (s.d.3.7%) of the registered population were dispensed a statin for any indication and that 6.3% (s.d. 3.0%) received a statin for primary CVD prevention. The regression model explained 21.2% of the variation in estimates of prescribing for primary prevention. Practices with higher prevalence of hypertension (β co-efficient 0.299 p <0.001) and diabetes (β co-efficient 0.566 p < 0.001) prescribed more statins for primary prevention. Practices with higher levels of ethnicity (β co-efficient-0.026 p <0.001), greater deprivation (β co-efficient -0.152 p < 0.001) older patients (β co-efficient -0.032 p 0.002), larger lists (β co-efficient -0.085, p < 0.001) and were more rural (β co-efficient -0.121, p0.026) prescribed fewer statins. In a small proportion of practices (0.5%) estimated prescribing rates for statins were so low that insufficient prescriptions were issued to meet the predicted secondary prevention requirements of their registered population.
  
  
  CONCLUSIONS
  Absolute estimated prescribing rates for primary prevention of CVD were 6.3% of the population. There was evidence of social inequalities in statin prescribing for primary prevention. These findings support the recent introduction of a financial incentive for primary prevention of CVD in England.
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK. r.fleetcroft@uea.ac.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: Fleetcroft
authors.forename: Peter
authors.initials: P
authors.lastname: Schofield
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011322:Primary Prevention
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors