1. Statin use in adults at high risk of cardiovascular disease mortality: cross-sectional analysis of baseline data from the Irish Longitudinal Study on Ageing (TILDA)
C. Murphy 1, K. Bennett 1, E. Shelley 2, I. Graham 3, T. Fahey 2, RA Kenny1
1. Trinity College Dublin 2. Royal College of Surgeons in Ireland 3. Department of Cardiology, St. James Hospital, Dublin.
Introduction
The role of statins in the secondary prevention of cardiovascular disease (CVD) is well established. Statin therapy is also recommended as part of the management strategy for diabetics.
In asymptomatic individuals, statins are recommended if the Systematic COronary Risk Estimation (SCORE) of 10 year CVD mortality is high (≥5% and <10%) or very high (≥10%) and Low- Density Lipoprotein (LDL-C) levels are above defined intervention thresholds.
Aim and Objectives
To examine the extent to which statins are used by adults at high risk of CVD compared to European clinical guidelines. The high risk groups examined are those with
Known CVD
Known diabetes
High or very high SCORE risk
Results
The response rate to the TILDA survey as a whole was 62%. In those aged years the mean age was 56.7 years, 45% were male (Table 1).
Almost 5% (n=166) were known to have CVD and 4.2% (n=141) were known to have diabetes (Figure 1).
SCORE risk was estimated in those without CVD or diabetes (n=3065), 40.9% were at low risk, 54.4% at moderate risk, 4.0% at high risk and 0.6% at very high risk of 10 year CVD mortality. In total 4.6% (n=142) were classified at high or very high risk for CVD mortality; this was higher in males compared to females (Figure 2).
In those with CVD, 68.6% (95% CI 61.5% to 75.9%) were taking statins (Figure 3). In diabetics, 57.4% (95% CI 49.1%-65.7%) were on statins and in those whose SCORE risk was ≥5% only 19.7% (95% CI 13.0% to 26.3%) were found to be taking statins.
Over a third (38.5%) of those with known CVD, 46.8% of those with known diabetes and 85.2% of those with a SCORE risk ≥5% were at or above the low-density lipoprotein cholesterol (LDL-C) target of 2.5 mmol/L specified in the 2007 European guidelines (Table 2). Higher proportions in each high risk group were at or above the total cholesterol guideline target of 4.5 mmol/L (Table 3).
In 2012 the target LDL-C for those with CVD was reduced to <1.8mmol/L in the European guidelines. Just over a quarter of the CVD group (27.7%) were at or below the recommended LDL-C target for secondary prevention using the updated guidelines which were published within a year of data collection completion.
Based on the 2012 guidelines we estimate that approximately 52,000 individuals aged yrs were on suboptimal statin treatment compared to the clinical guideline recommendations.
Full paper can be accessed at:
BMJ Open 2015;5:e008017 doi: /bmjopen
Table 1: Characteristics of the sample (50-64 years)
Table 2: Percentage of individuals with LDL-C above and below cut-offs defined in European guidelines 2007
Table 3: Percentage of individuals with serum total cholesterol above and below cut-offs defined in European guidelines 2007
Method
Cross-sectional study
TILDA baseline wave ( )
Representative sample of community living older adults in Ireland aged 50 years and older
Home based interview
Health centre or home based health assessment
Analysis limited to those aged years
Self-report of CVD (angina, myocardial infarction, bypass surgery, angioplasty or stent, stroke or transient ischaemic attack) and diabetes based on ever having a doctor’s diagnosis
CVD risk in those without CVD or diabetes was calculated using the SCORE ‘low’ risk country equations
Conclusion
Despite strong evidence and clinical guidelines supporting the use of statins for secondary prevention of CVD, this study reveals a gap between guidelines and clinical practice in this cohort. An immediate policy response is required to strengthen secondary prevention for those with existing CVD.
For the remainder of the population without evidence of CVD, population strategies for primary prevention are required as well as opportunistic risk assessment to identify those at high risk of future CVD in order to establish best practice in primary prevention
Figure 2: SCORE 10 year risk of CVD mortality by sex in those without CVD or diabetes
Contact
Catriona Murphy, TILDA, Lincoln Gate, Trinity College, Dublin 2
Phone:
Figure 1: Flow chart of the number of participants included in the analysis
Figure 3: Statin utilisation in groups at high risk of CVD
TILDA is supported by the Department of Health, Irish Life and the Atlantic Philanthropies. This work was funded by the Health Research Board in Ireland under Grant No: ICE/2012/7. We acknowledge Dr. Marie Therese Cooney for providing STATA code for SCORE.