Homer Kate, Boomla Kambiz, Hull Sally, Dostal Isabel, Mathur Rohini, Robson John
Centre for Primary Care and Public Health, Queen Mary University of London, London.
Br J Gen Pract. 2015 Aug;65(637):e538-44. doi: 10.3399/bjgp15X686113.
The updated (2014) National Institute for Health and Care Excellence (NICE) guideline lowered the recommended threshold for statin prescription from 20% to 10% 10-year cardiovascular disease (CVD) risk.
To determine the characteristics of patients prescribed statins for primary prevention according to their CVD risk.
Cross-sectional study in primary care settings in the three east London CCGs (Newham, City and Hackney, and Tower Hamlets).
Data were extracted from electronic health records of 930 000 patients registered with 137 of 141 general practices for a year ending 1 April 2014.
Of 341 099 patients aged 30-74 years, excluding those with CVD or diabetes, 22 393 were prescribed statins and had a 10-year CVD risk recorded. Of these, 9828 (43.9%) had a CVD risk ≥20%, 7121 (31.8%) had a CVD risk of 10-19%, and 5444 (24.3%) had a CVD risk <10%. Statins were prescribed to 9828/19 755 (49.7%) of those at ≥20% CVD risk, to 7121/37 111 (19.2%) of those with CVD risk 10-19%, and to 5444/146 676 (3.7%) of those with CVD risk <10%. Statin prescription below the 20% CVD risk threshold targeted individuals in the 10-19% risk band in association with hypertension, high serum cholesterol, positive family history, older age, and south Asian ethnicity.
This study confirms continuing undertreatment of patients at highest CVD risk (≥20%). GPs prescribed statins to only one-fifth of those in the 10-19% risk band usually in association with known major risk factors. Only 3.7% of individuals below 10% were prescribed statins.
更新后的（2014年）英国国家卫生与临床优化研究所（NICE）指南将他汀类药物处方的推荐阈值从10年心血管疾病（CVD）风险20%降至10%。
根据心血管疾病风险确定接受他汀类药物一级预防的患者特征。
在伦敦东部三个临床委托小组（纽汉、城市与哈克尼以及陶尔哈姆莱茨）的基层医疗环境中进行的横断面研究。
从141家全科诊所中的137家登记的930000名患者的电子健康记录中提取数据，截止日期为2014年4月1日。
在341099名年龄在30 - 74岁之间、排除患有心血管疾病或糖尿病的患者中，22393人被开具他汀类药物并记录了10年心血管疾病风险。其中，9828人（43.9%）的心血管疾病风险≥20%，7121人（31.8%）的心血管疾病风险为10 - 19%，5444人（24.3%）的心血管疾病风险<10%。心血管疾病风险≥20%的人群中，9828/19755（49.7%）的人被开具了他汀类药物；心血管疾病风险为10 - 19%的人群中，7121/37111（19.2%）的人被开具了他汀类药物；心血管疾病风险<10%的人群中，5444/全部146676（3.7%）的人被开具了他汀类药物。低于20%心血管疾病风险阈值开具他汀类药物针对的是风险处于10 - 19%区间且伴有高血压、高血清胆固醇、家族史阳性、年龄较大以及南亚族裔的个体。
本研究证实心血管疾病风险最高（≥20%） 的患者持续治疗不足。全科医生仅为风险处于10 - 19%区间且通常伴有已知主要风险因素的人群中的五分之一开具他汀类药物。风险低于10%的个体中只有3.7%的人被开具了他汀类药物。
