Cohort study investigating the relationship between cholesterol, cardiovascular risk score and the prescribing of statins in UK primary care: study protocol.
Cohort study investigating the relationship between cholesterol, cardiovascular risk score and the prescribing of statins in UK primary care: study protocol.
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DOI：
10.1136/bmjopen-2016-013120
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发表时间：
2016-11-17
期刊：
影响因子：
2.9
通讯作者：
Marshall T
中科院分区：
文献类型：
--
作者：
Finnikin S;Ryan R;Marshall T
风险评分是预防心血管疾病(CVD)不可或缺的一部分，应该成为决定提供降胆固醇药物(他汀类药物)的基础。然而，有文献表明，许多患者仍然是基于胆固醇升高而不是心血管疾病风险增加而开始服用他汀类药物。因此，重要的是要调查血脂水平和心血管疾病风险在决定开处方中所起的作用。这项研究将确定胆固醇水平和心血管疾病风险如何独立影响他汀类药物在初级保健中用于心血管一级预防的处方。健康改善网络(Thin)是一个编码的初级保健电子患者记录的数据库，来自500多个英国普通诊所。根据这一资源，将创建一个历史队列，这些患者没有被诊断为心血管疾病，目前没有接受他汀类药物的处方，并进行了血脂谱测量。将为这些患者计算后QRISK2评分，并将对他们进行60 天的随访，以确定他们随后是否服用了他汀类药物。初步分析将包括使用多变量Logistic回归建立预测模型，潜在预测因素包括胆固醇水平、计算的QRISK2评分、社会人口学特征和合并症。描述性统计将被用来确定处方的趋势，进一步的二级分析将探索哪些其他因素可能影响了他汀类药物的处方和处方间差异的程度。东南多中心研究伦理委员会于2003年批准了精简数据收集计划。使用THIN的个别研究需要科学审查委员会的批准。这项研究的原始议定书和随后的修正案已获批准(16THIN009A1)。研究结果将发表在同行评议期刊上，并在国内和国际会议上公布。
Risk scoring is an integral part of the prevention of cardiovascular disease (CVD) and should form the basis for the decision to offer medication to reduce cholesterol (statins). However, there is a suggestion in the literature that many patients are still initiated on statins based on raised cholesterol rather than a raised CVD risk. It is important, therefore, to investigate the role that lipid levels and CVD risks have in the decision to prescribe. This research will establish how cholesterol levels and CVD risk independently influence the prescribing of statins for the primary prevention of CVD in primary care. The Health Improvement Network (THIN) is a database of coded primary care electronic patient records from over 500 UK general practices. From this resource, a historical cohort will be created of patients without a diagnosis of CVD, not currently receiving a prescription for statins and who had a lipid profile measured. A post hoc QRISK2 score will be calculated for these patients and they will be followed up for 60 days to establish whether they were subsequently prescribed a statin. Primary analysis will consist of predictive modelling using multivariate logistic regression with potential predictors including cholesterol level, calculated QRISK2 score, sociodemographic characteristic and comorbidities. Descriptive statistics will be used to identify trends in prescribing and further secondary analysis will explore what other factors may have influenced the prescribing of statins and the degree of interprescriber variability. The THIN Data Collection Scheme was approved by the South-East Multicentre Research Ethics Committee in 2003. Individual studies using THIN require Scientific Review Committee approval. The original protocol for this study and a subsequent amendment have been approved (16THIN009A1). The results will be published in a peer review journal and presented at national and international conferences.
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