Statin initiations and QRISK2 scoring in UK general practice: a THIN database study

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Background: Statin prescribing should be based on cardiovascular disease (CVD) risk, but evidence suggests overtreatment of low-risk groups and undertreatment of high-risk groups. Aim: To investigate the relationship between CVD risk scoring in primary care and initiation of statins for the primary prevention of CVD, and the effect of national guideline change in 2014. Design and Setting: Historical cohort study using UK electronic primary care records. Method: We created a cohort of statin naïve patients without CVD between 01/01/2000 and 31/12/2015. We identified CVD risk scores (calculated using QRISK2 available from 2012) and statin initiations. We calculated rates of CVD risk score recording and analysed relationships between CVD risk category (low-, intermediate- and high-risk: <10%, 10-19.9% and ≥20% ten-year CVD risk) and statin initiation. Results: We identified 1.4 million patients from 248 practices. 151,788 had a recorded CVD risk score since 2012 (10.67%) and 217,860 were initiated on a statin (15.31%). Among patients initiated on a statin after 2012, 27.1% had a documented QRISK2 score: 2.7% of low-risk, 13.8% of intermediate-risk, and 35.0% of high-risk patients were initiated on statins. Statin initiation rates halved from a peak in 2006. After the 2014 guidelines, statin initiation rates declined in high-risk patients but increased in intermediate-risk patients. Conclusion: Most patients initiated on statins had no QRISK2 score recorded. Most patients at high CVD risk were not initiated on statins. 1 in 6 statin initiations were to low-risk patients indicating significant overtreatment. Initiations of statins in intermediate-risk patients rose after guidelines changed 2014.
Original languageEnglish
Pages (from-to)e881-e887
JournalBritish Journal of General Practice
Issue number665
Early online date23 Oct 2017
Publication statusPublished - Dec 2017


  • hydroxymethylglutaryl-CoA reductase inhibitors
  • General Practice
  • Risk Assessment
  • Primary Prevention
  • Statins
  • clinical guidance


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