Implications for service provision
Using a UK CVD policy model, developed using large contemporary UK population data, and the current best evidence for the beneficial and adverse effects of statin therapy, this study has shown that lifetime statin therapy is highly cost-effective across all UK adults ≥ 40 years old, suggesting that both improvements in statin uptake and widening of statin eligibility need to be considered in addition to monitoring the impact on statin uptake and adherence across population strata including hard-to-reach groups.
The CVD microsimulation model, and healthcare costs and QoL models, developed in this project are freely available to researchers, practitioners and policy-makers and could inform further strategies for individualised CVD management.
Suggested research needs
The following areas for further research were identified during the project development:
- The value of statin treatment for people at moderate CVD risk would decrease if there were further, as yet unknown, adverse effects of statin therapy. The ongoing work of the CTTC has the potential to importantly strengthen the evidence for the efficacy and safety of statin therapy.
- There is no conclusive direct evidence of cardiovascular risk reductions with statin therapy among participants > 75 years old without previous CVD. Two large, ongoing randomised trials in older people, scheduled to complete in 2026, will add to the evidence.82,83
- It has been also hypothesised that many people < 40 years of age are also likely to benefit; however, data on the effects of statins in younger people, beyond the category of familial hypercholesterolemia, are limited.
- To provide a more definitive value assessment of statin treatment in younger and older categories of the population, future decision-analytic models would require high-quality cohort data in younger adults and people in their 80s and 90s, categories not typically well represented in research.
- In view of some evidence of a potentially more limited impact of key cardiovascular events, including MI, on QoL, high-quality contemporary studies of the temporal impact of cardiovascular and other disease events on HRQoL are also required to inform future economic analyses.
6.Further research into the implications of multimorbidity and polypharmacy for prioritising effective preventive interventions in older people is likely to be informative.