Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide, totalling almost one-third of all deaths. Lipid optimisation is a key public health priority to decrease CVD morbidity, mortality and consequential economic burden on healthcare systems. A reduction in cholesterol by 1 mmol with statin therapy reduces the risk of CVD events by 20%–24%, in people with an estimated 10 year CVD risk greater than 10%. In the UK, the National Institute of Clinical Excellence (NICE) recommends atorvastatin 20 mg for primary prevention of CVD in these people, using QRISK2 to estimate their level of risk.
Purpose To assess adherence to NICE lipid modification guidance in patients presenting with acute coronary syndrome (ACS).
Material and methods Data on lipid-lowering therapy was collected prospectively, over an 8 week period in August 2018, for all patients presenting with ACS. QRISK2 scores were calculated for patients admitted with ACS naïve to statin therapy. Ethics approval was not required.
Results Two-hundred and fifty-two patients presented with ACS: mean total cholesterol and low-density lipoprotein (LDL) levels on admission were 4.7 and 2.8 mmol/L respectively. One-hundred and thirty-six (54%) patients were naïve to statin therapy prior to admission, of these 91 (67%) had a QRISK2 score greater than 10% (mean 18.45%). All patients were subsequently discharged on high-intensity statins, 124 (91%) on atorvastatin 80 mg.
Conclusion Two-thirds of patients naïve to statin therapy prior to admission had a 10 year CVD risk of 10% or greater, as estimated using QRISK2, and would have been eligible for atorvastatin 20 mg for primary prevention of CVD as per NICE guidance. Identifying patients in primary care at risk of CVD events is key to ensuring appropriate lifestyle modifications are undertaken and statin therapy initiated, both of which have been shown to reduce CVD event rates. Community services, such as NHS health checks at community pharmacies, and development of GP practice-based pharmacists should be targeted and supported by secondary care to ensure high-risk patients are prescribed optimum lipid modification therapy for primary prevention of CVD, thereby reducing the risk of CVD morbidity, mortality and associated financial implications to the health system.
References and/or acknowledgements https://www.nice.org.uk/guidance/cg181/chapter/1-Recommendations#lipid-modification-therapy-for-the-primary-and-secondary-prevention-of-cvd-2
No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.