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Patients at 10% risk shun offer of statin from their GP

Only a tenth of patients with a 10-20% predicted risk of cardiovascular disease chose to take a statin when given the opportunity, a study by GPs has revealed.

A practice in Cambridgeshire invited more than 400 patients who had previously attended an NHS Health Check appointment and had a QRISK2 score of between 10% and 20% to come in for an appointment at a specially arranged clinic to discuss starting statins.

Of 410 patients invited, just 100 (24.4%) attended the clinic – and only 45 (11%) started on a statin.

The GPs – who have now published their findings in the International Journal of Clinical Practice – said this suggested people at relatively low risk of cardiovascular disease were less inclined to start statin therapy than NICE experts had expected.

NICE predicted that only 20% of patients at 10-20% risk would refuse the offer of statins when it released its updated lipid modification guidelines last year.

However, a Pulse investigation showed GPs’ prescribing of statins had barely changed since NICE’s lowered threshold was introduced last summer – suggesting GPs were reluctant to push wider statin on the low-risk population.

And the latest study suggests that low-risk patients are equally reticent about taking statins.

The Firs House Surgery sent the patients an information leaflet along with their invite, which provided information on the new NICE recommendation, the way risk is calculated and what the benefits and harms of statins are – based on the National Prescribing Centre Statins Patient Decision aid.

The GPs found:

  • Older people and those with a higher QRISK Score within the 10-20% range were more likely to end up taking a statin;
  • Both ex- and current smokers were more likely to start a statin than non-smokers
  • Patients who opted not to start treatment most commonly cited preferring to initially try lifestyle changes as the main reasons;
  • Concern about side effects was less commonly reported.

One of the GPs, Dr Simon Poole, GPC member and chair of Cambridgeshire LMC – who is an outspoken critic of statins at the lower risk level – stressed to Pulse the information given to patients about the option to take statins was ‘neutral’.

Dr Poole said: ‘Simply asserting that doctors are failing patients because statin prescriptions for low risk patients have not soared following the new NICE guidance, or proposing to use incentives to increase statin prescriptions, ignores the voice of the individual patient and their right to determine their own treatment.’

Dr Andrew Green, chair of the GPC’s clinical prescribing subcommittee said the study ‘will fit in with the clinical experience of many GPs’.

Dr Julian Treadwell, vice-chair of the RCGP’s standing group of over-diagnosis, said it was ‘a fascinating small study’ with the result showing low uptake among patients ‘after receiving well balanced information’.

However, Dr Treadwell cautioned that the study was done ‘in just one practice in a relatively affluent area so we must be cautious about applying the result to the whole population’.

A NICE spokesperson responded: ’The NICE guidance is very clear: it is only after lifestyle changes are considered first, followed by other risk factors such as hypertension, that people who are at risk should be offered the opportunity to use a statin, if they want to.

‘They don’t have to, and indeed the authors of this study identify the most common reason for not starting a statin in the study were either not wanting to take medication or preferring to initially change their lifestyle.’

They added that the results of this study ‘should be interpreted with caution’.

Int J Clin Prac 2015; available online 30 Sept


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