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, 183565 patients met the inclusion criteria (n=91479 for ASCVD, 92086 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- 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 up-titration and 680000 would require statin initiation (31% de-novo initiation, 60% re-initiation, 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 up-titration and 1.4 million would require statin initiation (59% de-novo initiation, 36% re-initiation, 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 ASCVD patients and 85% of high-risk non-ASCVD individuals, representing approximately 3 million individuals in each group, would require statin up-titration or initiation to achieve full concordance with updated guidelines.