Retrospective examination of lipid-lowering treatment patterns in a real-world high-risk cohort in the UK in 2014: comparison with the National Institute for Health and Care Excellence (NICE) 2014 lipid modification guidelines

Feb 19, 2017BMJ open

Lipid-lowering treatment patterns in high-risk UK patients in 2014 compared to national guidelines

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Abstract

Overall, 183,565 patients met the inclusion criteria for assessing lipid-modifying therapy following updated NICE guidelines.

In patients with atherosclerotic cardiovascular disease (ASCVD), 79% were treated with statins, and 31% received high-intensity statin therapy.
Among high-risk non-ASCVD patients, 62% were on a statin, with 57% receiving medium or high-intensity statins.
Only 6% of ASCVD patients and 15% of non-ASCVD patients were treated according to the updated NICE dosing recommendations.
Extrapolation indicated that 2.4 million individuals with ASCVD in the UK would need statin uptitration and 680,000 would require new statin prescriptions to align with guidelines.
For high-risk non-ASCVD individuals, 1.6 million would need statin uptitration, while 1.4 million would require initiation of statin therapy.

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BACKGROUND: In 2014, guidelines from the National Institute for Health and Care Excellence (NICE) provided updated recommendations on lipid-modifying therapy (LMT). We assessed clinical practice contemporaneous to release of these guidelines in a UK general practice setting for secondary and high-risk primary-prevention populations, and extrapolated the findings to UK nation level.

METHODS: Patients from The Health Improvement Network database with the following criteria were included: lipid profile in 2014 (index date); ≥20 years of age; ≥2 years representation in database prior to index; ≥1 statin indication either for atherosclerotic cardiovascular disease (ASCVD) or the non-ASCVD conditions high-risk diabetes mellitus and/or chronic kidney disease.

RESULTS: Overall, 183 565 patients met the inclusion criteria (n=91 479 for ASCVD, 92 086 for non-ASCVD). In those with ASCVD, 79% received statin treatment and 31% received high-intensity statin. In the non-ASCVD group, 62% were on a statin and 57% received medium-intensity or high-intensity statin. In the ASCVD and non-ASCVD cohorts, 6% and 15%, respectively, were already treated according to dosing recommendations as per updated NICE guidelines. Extrapolation to the 2014 UK population indicated that, of the 3.3 million individuals with ASCVD, 2.4 million would require statin uptitration and 680 000 would require statin initiation (31% de novo initiation, 60% reinitiation, 9% addition to non-statin LMT) to achieve full concordance with updated guidelines. Of the 3.5 million high-risk non-ASCVD individuals, 1.6 million would require statin uptitration and 1.4 million would require statin initiation (59% de novo initiation, 36% reinitiation, 5% addition to non-statin LMT).

CONCLUSIONS: A large proportion of UK individuals with ASCVD and high-risk non-ASCVD received statin treatment (79% and 62%, respectively) during the year of NICE 2014 guidelines release. Up to 94% of patients with ASCVD and 85% of high-risk non-ASCVD individuals, representing ∼3 million individuals in each group, would require statin uptitration or initiation to achieve full concordance with updated guidelines.

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