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

Abstract

BackgroundIn 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.MethodsPatients 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.ResultsOverall, 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).ConclusionsA 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.

Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany

“…A study in the Netherlands found that lipid-lowering therapy (LLT) was used in 67% of patients at high CV risk, and overall, 55% of patients achieved an LDL-C goal <2.6 mmol/L (<100 mg/dL) [10]. Similarly, among >180,000 high CV risk patients in the UK in 2014, 79% and 62% of ASCVD and non-ASCVD received statins, but only 31% and 26%, respectively, reached the LDL-C goal of <1.8 mmol/L (70 mg/ dL) [11]. In Germany, the proportions of patients with CVD achieving risk-based LDL-C goals with statins has ranged from 14% to 27% [12,13], and the proportion of German patients with CHD receiving lipid-lowering therapy has been reported to be less than 35% [14].…”

Achievement of European guideline-recommended lipid levels post-percutaneous coronary intervention: A population-level observational cohort study

“…Nevertheless, our observed HI-statin prescribing rate was considerably higher than documented in previous post-myocardial infarction studies, which have reported HI-statin therapy in only 4-31% of patients. 6,10,11 However, these observations were in different healthcare systems, 6,11 and in historical populations, 6 rather than a contemporary UK, post-PCI population.…”

Further options for treating lipids in people with diabetes: targeting LDL‐cholesterol and beyond

“…Meta-analysis in the Cholesterol Treatment Trialists' Collaboration showed that statin therapy reduced CVD death by 13% and CVD events by 21% per 1 mmol/l reduction in LDL-cholesterol [17]. Although long available, statins remain underused (and under-dosed) in people with diabetes in the UK [18]. Although long available, statins remain underused (and under-dosed) in people with diabetes in the UK [18].…”

“…All subsequent trials have been against the background of statin therapy. Although long available, statins remain underused (and under-dosed) in people with diabetes in the UK [18].…”