Improving detection and management of high cholesterol to prevent cardiovascular disease
Cholesterol-lowering treatment is an effective intervention for the primary and secondary prevention of cardiovascular conditions, such as stroke and myocardial infarction (commonly known as a heart attack). However, many people are unaware they have high cholesterol, or receive sub-optimal treatment for it.
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According to statistics from 2017, measured across both genders of all ages in London, high levels of low-density lipoprotein (LDL) cholesterol were responsible for 50.3 per cent of deaths from ischemic heart disease (IHD) and 11.7 per cent of deaths from stroke. Additionally, high LDL cholesterol was attributed to the percentage of years that people lived with disability following IHD or a stroke, which was 50.2 per cent and 20.7 per cent respectively1.
The NHS Long Term Plan sets out an ambitious ten-year commitment to prevent 150,000 heart attacks, strokes and cases of dementia by improving the detection and management of the following high-risk conditions: atrial fibrillation (AF), high blood pressure and high cholesterol.
In primary and secondary prevention studies, lowering LDL cholesterol by one millimole per litre (mmol/L) reduces the relative risk of major vascular events by 21 per cent, total mortality by nine per cent and stroke (of any type) by 15 per cent, irrespective of baseline cholesterol and gender.
Although treatment of high cholesterol is highly effective at preventing cardiovascular conditions, under-treatment is common, with substantial geographical variation and health inequalities across the country.
Opportunities exist to drive improvements in cholesterol management by making use of primary care data, through the development of new clinical care pathways in primary care to deliver improved identification, treatment and monitoring. This will ensure patients are more easily identified and treated without adding to GP workload.
The NHS Accelerated Access Collaborative (AAC) selects products to be part of its Rapid Uptake Product (RUP) programme for rollout support across NHS trusts in England. The Health Innovation Network works with our local trusts in south London to support the adoption of these products or recommended pathways, as well as to help address barriers to uptake.
PCSK9 Inhibitors, part of this year’s RUP programme, are a treatment for very high cholesterol and are used together with statin-type lipid-lowering medicines, or in those who are unable to take or tolerate a statin, which is a type of medicine that can help lower LDL cholesterol levels in blood. Two options are available in the PCSK9 Inhibitor class of medicine, both recommended by the National Institute for Health and Care Excellence (NICE): alirocumab and evolocumab. PCKS9 Inhibitors were selected as an RUP having met set criteria, including cost effectiveness and evidence of clinical benefit, but with a level of adoption lower than expected.
“Heart attacks and strokes are life-changing events for sufferers and their families, and the NHS long term plan will set out a strategy for cardiovascular disease prevention and care. Thankfully these conditions are highly preventable and minimising their impact is not just good for patients but also benefits taxpayers who fund the NHS.”
Dr Matt Kearney, GP and National Clinical Director for Cardiovascular Disease Prevention at NHS England
How can innovation help?
We’d love to collaborate with you, as an innovator, on the following challenge questions in response to our local needs in south London:
1. What digital solutions exist for primary care to optimise the detection, treatment and monitoring of high cholesterol?
2. What digital solutions exist to help patients self-manage their cholesterol levels and general cardiovascular well-being?
3. How can digital solutions reach people in higher risk groups, including those with underlying health conditions or living with socio-economic inequalities?
Please get in touch with Karla Richards if you have a digital solution for preventing cardiovascular disease, including lipid management and addressing the problems associated with high cholesterol.
Desired impact / outcomes:
The desired outcomes of addressing this regional challenge are:
• enabling the NHS to identify people in south London with high cholesterol and optimise management for people at increased cardiovascular risk;
• reducing the risk of cardiovascular events in people who are under-treated and managed in primary care, by pinpointing digital solutions that can be used for effective identification and treatment;
• identifying evidence-based innovations for self-management; and
• forming future partnerships between innovators and health and care teams.
GBD Visualisation Tool, Institute of Health Metrics and Evaluation. [vizhub.healthdata.org/gbd-compare/#] [Accessed: September 2018]