Improving adherence to treatment is likely to be a more effective approach to reduce CVD risk than lowering the threshold for statin use, a modelling study has shown.

This study aimed to compare the two strategies to increase statin uptake in at-risk patients. Trial and clinical practice data were analysed by the authors to calculate an average capacity to adhere to treatment over ten years. They then gathered data from the Melbourne Collaborative Study which included blood pressure and total cholesterol measurements of 38,268 individuals. This data was used to estimate the risk of incident CVD and CVD mortality using the two different strategies.

The authors predicted 5,390 new cases of CVD and 710 related deaths within ten years. Using the current ≥20% risk of CVD treatment threshold, 24% of these individuals would be eligible for statin therapy, and with an assumed adherence of 50%, 174 new cases of CVD and 70 deaths would be prevented.

If adherence was taken to be 75% this resulted in an additional 6,971 individuals taking statin therapy by ten years, which in turn would prevent 91 additional cases of CVD and 37 related deaths. This approach was more effective than lowering treatment thresholds until 6,991 individuals became eligible for therapy which resulted in the prevention of 70 new cases of CVD and 18 related deaths.

Adherence rates in a community setting often fail to come anywhere near those reported in clinical trials and at five years only around 50% of patients continue to take their medication.

Although one must always interpret studies based on models and assumptions with a degree of caution,

I think it illustrates an important point. We should probably concentrate more on ensuring that patients continue to take preventative pharmacotherapies rather than focusing on ever more aggressive intervention thresholds.

Dr Peter Savill