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

Samuel Finnikin*, Brian H. Willis, Ronan Ryan, Tim Evans, Tom Marshall

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review



    Initiation of statins for the primary prevention of cardiovascular disease (CVD) should be based on CVD risk estimates, but their use is suboptimal.


    To investigate the factors influencing statin prescribing when clinicians code and do not code estimated CVD risk (QRISK2).

    Design and setting

    A historical cohort of patients who had lipid tests in a database (IQVIA Medical Research Data) of UK primary care records.


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


    Of the entries, 146 693 (21.4%) had a coded QRISK2 score. Statins were initiated in 6.6% (95% confidence interval [CI] = 6.4% to 6.7%) of those with coded and 4.1% (95% CI = 4.0% to 4.1%) of uncoded QRISK2 ( P< 0.001). Statin initiations were consistent with National Institute for Health and Care Excellence guideline recommendations in 85.0% (95% CI = 84.2% to 85.8%) of coded and 44.2% (95% CI = 43.5% to 44.9%) of uncoded QRISK2 groups ( P< 0.001). When coded, QRISK2 score was the main predictor of statin initiation, but total cholesterol was the main predictor when a QRISK2 score was not coded.


    When a QRISK2 score is coded, prescribing is more consistent with guidelines. With no QRISK2 score, 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
    Pages (from-to)E219-E225
    Number of pages7
    JournalBritish Journal of General Practice
    Issue number704
    Publication statusPublished - Mar 2021

    Bibliographical note

    Publisher Copyright:
    © The Authors


    • Cardiovascular diseases
    • Cholesterol
    • Decision making
    • General practice
    • Hydroxymethylglutaryl-CoA reductase inhibitors
    • Risk assessment
    • Shared
    • shared
    • risk assessment
    • cardiovascular diseases
    • general practice
    • decision making
    • cholesterol
    • hydroxymethylglutaryl-CoA reductase inhibitors


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