Are Statins Optimally Prescribed to Reduce Stroke Risk in Patients with Hypercholesterolaemia? A population-based Longitudinal Study Using Electronic Health Records in South London (2005–2021)
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Background
We aim to evaluate the impact of statin prescription on the risk of stroke in patients with hypercholesterolaemia.
Methods
We analysed electronic health records from patients with hypercholesterolaemia, registered in 41 general practices in south London between 2005 and 2021. Association between cumulative incidence of stroke and statin prescription, adjusted for history of heart diseases (HHD), was evaluated using a proportional subdistribution hazard model. Restricted mean stroke-free survival was evaluated in patients with stroke relative to statin prescription. Association between statin prescription and patients’ sociodemographics was evaluated using logistic regression.
Results
Of the 849,968 registered patients, 168,570 (19.5%) had records of hypercholes-terolaemia. Among them, 33.5% were prescribed statins, 2.6% had a record of stroke, and 50.6% were female. 31.7%, 16.2%, 7.9%, and 3.4% had records of hypertension, diabetes, HHD, and atrial fibrillation, respectively. Statin prescription was associated with reduced hazard of stroke (adjusted subdistribution hazard ratio: 0.87, (95% confidence interval (CI): 0.81-0.93), p<0.001) or delayed onset of stroke, the restricted mean stroke-free survival at record of hypercholesterolaemia being 3.8 years longer in patients with prescribed statins (95% CI: from 3.4 to 4.1, p < 0.001). Statins were less likely prescribed to female patients and patients of Black ethnicity (Odds-ratio: 0.70, 95% CI: 0.68-0.72, p<0.001 and OR: 0.81, 95% CI: 0.78-0.83, p<0.001, respectively).
Conclusion
The benefit–risk balance of statins should be re-evaluated to optimise stroke prevention in patients with hypercholesterolaemia, while further efforts should be made to address disparities observed in statin prescription across gender groups and ethnic groups.
key messages
What is already known on this topic
If statins are widely recognised for their efficacy in reducing the risk of major cardiovascular events, including stroke, analysing their effectiveness in patients with hypercholesterolaemia remains challenging due to the complex relationship between hypercholesterolaemia and stroke. Moreover, questions remain regarding optimal prescription practices, particularly across different demographic groups, and the impact of statins on long-term stroke prevention.
What this study adds
This study demonstrates the effectiveness of statin therapy in stroke prevention by either lowering the incidence of stroke or delaying its onset in patients with hypercholesterolaemia, extending stroke-free survival at record of hypercholesterolaemia by an average of 3.8 years. It also highlights disparities in statin prescription, with women and patients of Black ethnicity being less likely to receive statins.
How this study might affect research, practice, or policy
The findings suggest the need for greater attention to disparities in statin prescription practices, particularly across gender and ethnic groups, and the opportunity of expanding statin prescription to patients with untreated hypercholesterolaemia in accordance with current recommendations.
