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GPs ‘should prescribe statins to younger patients’ using 30-year risk score

GPs should prescribe statins for primary prevention to ‘younger, lower-risk’ patients, according to a new study. 

Researchers compared the use of different risk prediction algorithms and found that using 30-year absolute risk reduction was the ‘more optimal approach for determining statin eligibility’, as it identified ‘many additional low-risk individuals’ with high long-term expected benefits of taking statins.

But GPs warned that changing from the current 10-year risk calculator would increase their workload, as they would have to carry out the ‘bulk of prescribing and monitoring’ and called for more evidence that such a change would be cost-effective. 

Researchers looked at a total of 1,688 patients, representing 56.6m US individuals, who were aged between 40 to 60 years old, from November 2017 to August 2018.

They selected patients who did not have cardiovascular disease, diabetes, or LDL-C levels greater than 190 mg/dL, and who were not taking statins.

The research team calculated 10-year risk of cardiovascular disease and 10-year and 30-year absolute risk reduction of cardiovascular disease for each individual, and found that the absolute risk reduction approaches were better able to avoid treatment of individuals with low expected benefit.

They noted that patients who met statin eligibility based on the 30-year absolute risk reduction threshold for treatment were younger (mean age 50 years) and more likely to be women than those recommended with a 10-year absolute risk reduction threshold.

The study, published in JAMA Cardiology, said: ‘A long-term benefit approach identifies younger, lower-risk individuals with high LDL-C levels for statin treatment and thus provides a more optimal approach for determining statin eligibility in primary prevention.’

‘We demonstrate that using a 30-year benefit-based approach identifies many additional low-risk individuals with a high calculated benefit of long-term statin therapy, without extending treatment to individuals at low benefit,’ it added.

But London-based GP Professor Azeem Majeed, head of primary care and public health at Imperial College London, warned that such a change would have a knock-on effect in general practice.

He explained: ‘The way the current QRISK formula is used means that people who will be at high risk when they are older will not be placed on statins early in their life. Hence, there is some debate about switching to a lifetime risk rather than a 10-year risk of CVD.

‘The limitation of changing current UK policy would be that many more people would become eligible for statins, thereby increasing NHS workload – particularly for general practices as they would be responsible for the bulk of prescribing and monitoring. Also, we would need more evidence that this would be a cost-effective use of NHS resources.’

NICE recently agreed to review recommendations for statins prescribing in over 75s for primary prevention, following new research which found that they did not effectively reduce the risk of heart attacks or stroke in older patients, unless they had diabetes and were also under 84 years old.

Another major study found ‘no evidence’ that lowering hypertension thresholds to treat low-risk patients with mild hypertension has any benefit.