Exploring the effectiveness of statins for primary prevention of cardiovascular disease in people with severe mental illness

Cardiovascular disease (CVD) is the leading cause of death amongst people with severe mental illness (SMI) and drives substantial portion of the 15-20 year deficit in life expectancy experienced by this group relative to the general population. Statins form a core part of CVD prevention in the general population, but the evidence-base for people with SMI is unclear. Evidence on the effectiveness of statins for primary prevention of CVD was systematically searched but did not identify any studies investigating CVD events or associated mortality in people with SMI; therefore highlighting the need for studies on the long term impacts of statin prescribing. Two analytical studies were undertaken using longitudinal data from The Health Improvement Network (THIN) primary care database to investigate: 1) CVD screening and statin prescribing in people with and without SMI and 2) to explore the effectiveness of statins for CVD prevention in individuals with SMI. Collectively the work has established that CVD screening and statin prescribing is increasingly accessed by individuals with SMI at levels that are comparable to people without similar mental health conditions. The results from this study provide the first evidence that statin prescribing to people with SMI is associated with statistically significant reductions in total cholesterol (of 1.2mmol/L for up to 2 years, p < 0.001). There were small non-significant reductions in the rate of combined MI and stroke (0.89; 95% CI; 0.68-1.15) and all-cause mortality 0.89 (95% CI; 0.78, 1.02). This study provides evidence that statin prescribing to people with SMI may have a magnitude of effectiveness that is broadly similar to the general population.