Statin criteria should add absolute risk

INCORPORATING absolute cardiovascular risk assessment into the PBS criteria for prescribing lipid-lowering medications could allow more people to benefit from statins, an expert says.

Responding to an MO poll that showed 61% of GPs believed the current PBS criteria were too strict, Professor Simon ­Stewart, head of preventative cardiology at the Baker IDI Heart and Diabetes Institute, said the PBS needed to take account of the move towards absolute risk reduction. 

“The PBS has embraced this somewhat, but if they went further, and there were more updated guidelines around absolute risk reduction, and they advocated getting people to lower cholesterol targets than before, then I can see the PBS changing accordingly,” he said.

Associate Professor Leon Simons, director of the lipid research department at Sydney’s St Vincent’s Hospital, said the current criteria were a little complex but represented a good compromise in making certain the right mix of patients were being prescribed the drugs.

Around 40% of GPs responding to the poll said they would prescribe lipid-lowering medication on private prescription if they believed it was in the patient’s interest.

The poll, conducted by Cegedim Strategic Data on behalf of MO, also showed half of GPs considered the time taken to complete calculations was the key barrier when calculating a patient’s absolute risk score.

Professor Stewart pointed to simplified computerised tools, such as a National Heart Foundation online calculator, to facilitate absolute risk profiling.

“It’s easy to do and it’s well worth the effort,” he said. 

“The management of the patient should change to the overall picture of the patient, rather than their individual values.” 

He said patients weren’t defined by a single blood pressure measure, total cholesterol value or BMI.

“All of these things need to be considered and the absolute risk profiling is one way of pulling it all together. Your management should be around whole risk, rather than simple numbers,” he said.

Professor Stewart said GPs needed support to individualise primary care. 

“I think Medicare is going to have to at some point think about reimbursement along those lines,” he said.

Professor Simons said GPs and other healthcare professionals needed total and HDL cholesterol, blood pressure, cigarette use, diabetes and family history to complete the absolute risk calculation.

“This is a simple and quick exercise, and can prove to be a useful tool in patient education and motivation,” he said.

Nearly 20% of GPs who responded to the poll said an absolute risk calculator was not part of their existing practice computer software. 

This poll was conducted for Medical Observer by Cegedim Strategic Data research company.