- J P Sheppard, research fellow1,
- S Singh, clinical research fellow1,
- K Fletcher, research fellow1,
- R J McManus, professor2,
- J Mant, professor3
- Correspondence to: R J McManus richard.mcmanus@phc.ox.ac.uk
- Accepted 23 May 2012
Abstract
Objectives
To establish the impact of age and sex on primary preventive treatment
for cardiovascular disease in a typical primary care population.
Design Cross sectional study of anonymised patient records.
Participants
All 41 250 records of patients aged ≥40 registered at 19 general
practices in the West Midlands, United Kingdom, were extracted and
analysed.
Main outcome measures
Patients’ demographics, risk factors for cardiovascular disease (blood
pressure, total cholesterol concentration), and prescriptions for
primary preventive drugs were extracted from patients’ records. Patients
were subdivided into five year age bands up to 85 (patients aged ≥85
were analysed as one group) and prescribing trends across the population
were assessed by estimating the proportion of patients prescribed with
antihypertensive drug or statin drug, or both, in each group.
Results
Of the 41 250 records screened in this study, 36 679 (89%) patients did
not have a history of cardiovascular disease and therefore could be
considered for primary preventive treatment. The proportion receiving
antihypertensive drugs increased with age (from 5% (378/6978) aged 40-44
to 57% (621/1092) aged ≥85) as did the proportion taking statins up to
the age of 74 (from 3% (201/6978) aged 40-44 to 29% (675/2367) aged
70-74). In those aged 75 and above, the odds of a receiving prescription
for a statin (relative to the 40-44 age group) decreased with every
five year increment in age (odds ratio 12.9 (95% confidence interval
10.8 to 15.3) at age 75-79 to 5.7 (4.6 to 7.2) at age ≥85; P<0 .001=".001" by="by" consistent="consistent" differences="differences" in="in" no="no" p="p" prescribing="prescribing" sex.="sex." there="there" trends="trends" were="were">
Conclusions
Previously described undertreatment of women in secondary prevention of
cardiovascular disease was not observed for primary prevention. Low use
of statins in older people highlights the need for a stronger evidence
base and clearer guidelines for people aged over 75.
