Factors predicting statin prescribing for primary prevention: an historical cohort study

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Background: Initiation of statins for the primary prevention of cardiovascular disease (CVD) should be based on CVD risk estimates but their use is sub-optimal.

Aim: To investigate the factors influencing statin prescribing when clinicians code and do not code estimated CVD risk (QRISK2).Design and settingA historical cohort of patients who had lipid tests in a database of UK primary care records (IMRD).

Methods: The cohort comprised 686,560 entries (lipid test results) between 2012 and 2016 from 383,416 statin naïve patients, without previous CVD. Coded QRISK2 estimates were extracted, with variables used in calculating QRISK2 and factors that might influence statin prescribing. If QRISK2 was not coded, it was calculated post-hoc. The outcome was initiation of a statin within 60 days of the lipid test result.

Results: 21.4% of entries had a coded QRISK2 score. Statins were initiated in 6.6% (6.4%-6.7%) of those with coded and 4.1% (4.0%-4.1%) of un-coded QRISK2 (p<0.001). Statin initiations were consistent with NICE guideline recommendations in 85.0% (84.2%-85.8%) of coded and 44.2% (43.5%-44.9%) of un-coded QRISK2 groups (P<0.001). When coded, QRISK2 score was the main predictor of statin initiation, but total cholesterol was the main predictor when QRISK2 was not coded.

Conclusions: When QRISK2 is coded, prescribing is more consistent with guidelines. With no QRISK2 code, prescribing is mainly based on total cholesterol. Using QRISK2 is associated with statin prescribing that is more likely to benefit patients. Promoting the routine CVD risk estimation is essential to optimise decision making.


Original languageEnglish
Article numberbjgp20X714065
JournalBritish Journal of General Practice
Early online date8 Feb 2021
Publication statusE-pub ahead of print - 8 Feb 2021


  • cardiovascular diseases, cholesterol, decision making, shared, general practice, Hydroxymethylglutaryl-CoA reductase inhibitors, risk assessment