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

Background: In 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.

Methods: Patients 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.

Results: Overall, 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).

Conclusions: A 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.

Keywords: cardiovascular disease; guidelines; lipids; low-density lipoprotein cholesterol (LDL-C); statins.

Conflict of interest statement

Competing interests: DS receives modest consulting fees from Sanofi and Regeneron. IK is a stockholder and employee of Sanofi. DA is an employee of IMS Health. RJS is a stockholder and employee of Regeneron Pharmaceuticals, Inc. KKR has received honoraria for advisory boards, lectures or for serving on the steering committee for clinical trials from Amgen, Sanofi, Regeneron, Pfizer, AstraZeneca, Aegerion, Kowa, IONIS Pharma, MedCo, Cerenis and Resverlogix, and has received research support by grants to his institution from Pfizer, MSD, Amgen, Sanofi and Regeneron Pharmaceuticals, Inc.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1

Determination of treatment status as of the index date. Blue bars representing scenarios A and B (medication supply via recorded prescription (Rx) on or within 30 days prior to the index date) define the patient as being treated as of the index date. The red bar representing scenario C (medication supply via recorded Rx more than 30 days prior to the index date) defines the patient as not being treated as of the index date.

Figure 2

Flow chart of the cohort selection for the study. *ASCVD includes acute coronary syndrome, other coronary heart disease, ischaemic stroke/transient ischaemic attack and peripheral arterial disease. †Includes type 2 diabetes mellitus with QRISK2 ≥10%, type 1 diabetes mellitus with age >40 years and chronic kidney disease not meeting the previous diabetes mellitus criteria. ASCVD, atherosclerotic cardiovascular disease; CV, cardiovascular disease; THIN, The Health Improvement Network.