Lipid Testing among Patients Beginning Statin Therapy in General Practice in the United Kingdom

Abstract

Objectives To determine the frequency of lipid testing and to identify the factors predictive of lipid-testing frequency over a 1-year period in patients beginning statin treatment. Methods Retrospective cohort study performed using the UK General Practice Research Database. The patients were selected if they were ≥35 years of age, received first-ever statin between January 2000 and December 2004, had at least one total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), or triglyceride (TG) test conducted in the 1-year period before statin initiation, and had at least 1 year of follow-up data. The main outcome measures were TC, HDL-C, and TG testing frequencies in the year after initiating statins. Poisson regression was used to assess baseline factors associated with testing frequency for each lipid. Results In the year after initiating statins, the patients received a mean (±SD) of 1.3 (±1.0) TC tests, 0.9 (±1.0) HDL-C tests, and 0.9 (±1.0) TG tests; however, 22.7%, 44.3%, and 39.1% of the patients did not receive any TC, HDL-C, and TG tests, respectively. In multivariate analyses, a high coronary heart disease (CHD) risk (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01–1.07) and elevated baseline TC (≥6.2 vs. <5.0 mmol/L; OR 1.12; 95% CI 1.06–1.18) were significantly associated with greater TC testing frequency. Conclusions High risk of CHD and elevated baseline TC were associated with greater rates of TC testing in the year after statin initiation. Lack of TC testing in approximately one in five patients, and infrequent HDL-C and TG testing may be barriers to comprehensive lipid management.