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Statins in Primary Prevention of Cardiovascular Disease: Incidence of Potentially Inappropriate Prescriptions in Very Low Risk Primary Care Patients and Associated Factors

Abstract

Usue Elizondo-Alzola, Alvaro Sanchez, Jose I. Pijoan, Marta M. Mediavilla, Rita Sainz De Rozas, Itxasne Lekue, Arturo Garcia-Alvarez and Gonzalo Grandes

Objective: To quantify and characterize the initiation of Potentially Inappropriate Prescription (PIP) of statins in primary prevention of Cardiovascular Disease (CVD) in patients with low cardiovascular risk in the Basque Health Service (Osakidetza) by estimating the annual incidence rate and identifying the associated clinical and socio-demographic factors.

Methods: Analytical retrospective observational study on the incidence of PIP of statins and provision of advice for changing lifestyles in 2018. Patients aged 40 to 75 years with cardiovascular risk <5% (REGICOR) and LDL-cholesterol levels between 70 and 189 mg/dl and/or Total Cholesterol (TC) between 200 and 289 mg/dl. Sociodemographic and clinical characteristics and deprivation index were evaluated. Global incidence, factors associated with PIP and the variability between Integrated Health Organizations (IHOs) were analyzed.

Results: 70,526 people met the selection criteria. Of them, 741 started a PIP for statins with an overall incidence of 10.5 prescriptions per 1,000 person-years (ranging in IHOs from 2.3 to 18.0). Less than 40% of these people received preventive advice on physical activity and diet and approximately 50% received advice on cessation of smoking. PIPs were higher in men (RR 1.36), people with arterial hypertension (RR 1.86) and other comorbidities (RR 3.93 if ≥ 5 comorbidities); PIPs also increased with age (RR 1.02 per year) and TC levels (RR 1.21 per 10mg/of the increase).

Conclusion: This study shows that practice in primary CVD prevention in low-risk primary care patients does not seem to follow the recommendations of current guidelines. It is necessary to identify determinants associated with this low-value practice in order to inform the design and implementation of strategies to favor its abandonment.