University of Edinburgh

British Heart Foundation

DL_2024_014

Cardiovascular disease is a leading cause of death worldwide. Primary prevention focusses on individuals without known cardiovascular disease to prevent a first cardiovascular event through life style changes such as increasing physical activity, smoking cessation or reducing alcohol consumption or through medications like cholesterol-lowering drugs. However, in Scotland, trends in risk assessment and preventive medication prescription in individuals without established cardiovascular disease remain unclear. It is also unknown whether there are inequalities or differences between important subgroups, such as women and men or younger and older individuals. More insight on the risk assessment and management of therapy in primary prevention of cardiovascular disease in current practice is important to identify the gaps and where we can improve the adoption of preventative medication therapy to improve outcomes. In this study we aim to conduct an evaluation on trends and assess whether there are inequalities or differences in risk assessment, treatment and outcomes of individuals without cardiovascular disease by sex, age, ethnicity, severe mental illness, and deprivation status, while also exploring the feasibility of the novel federated data access approach.

There are around 7.6 million people currently living with cardiovascular diseases in the UK and the British Heart Foundation estimates that over half of the UK population will experience cardiovascular disease at some point in their lifetime. Primary cardiovascular prevention aims to reduce the probability of a first cardiovascular event in individuals without known cardiovascular disease. Risk assessment using cardiovascular risk scores, such as the ASSIGN risk score, facilitates the identification of individuals at the high risk of cardiovascular disease and those who would derive the greatest benefit from primary prevention therapy. Additionally, primary prevention therapies are recommended for individuals with diabetes, chronic kidney disease, micro- or macroalbuminuria, or familial hypercholesterolemia due to their elevated cardiovascular risk. Unfortunately, suboptimal risk assessment and treatment for primary prevention of cardiovascular disease have been observed over the last decades. At this point, the assessment of cardiovascular risk and use of primary prevention treatments in individuals without established cardiovascular disease in Scotland is unclear. Improvement in digitalization of electronical health records has created the unique opportunity to establish a data framework using routinely collected data to evaluate current clinical practice in a country. However, the use of granular routinely collected healthcare data is currently restricted to individual regional health boards across Scotland, limiting access to one region at a time. Recent collaborative efforts among health boards will enable data access across multiple regions through a federated approach, offering significant opportunities for a more comprehensive national view of clinical practice. We propose piloting the federated approach with two health boards (NHS Lothian, NHS Greater Glasgow & Clyde) to explore feasibility, address key practical challenges, and lay the foundation for expanding the evaluation of primary prevention strategies from a regional to a national scale. More insight on the risk assessment and management of therapy in primary prevention of cardiovascular disease in current practice is important to identify the gaps and where we can target improved adoption of risk assessment and preventative medication therapy in addition to other risk reduction interventions to improve outcomes. Our findings could also serve as a basis for the development of data-enabled tools or dashboards to provide general practitioners with insights into cardiovascular risk assessment within their practice settings.

Public Health Research

08/08/2025

De-Personalised

TRE