Long-term cardiovascular risks and statin treatment impact on socioeconomic inequalities: microsimulation model

Abstract

Background: UK cardiovascular disease (CVD) incidence and mortality have declined in recent decades but socioeconomic inequalities persist. Aims: We present a new CVD model and project health outcomes and impact of guideline-recommended statin treatment across quintiles of socioeconomic deprivation in UK. Design and Setting: Lifetime microsimulation model developed using 117,896 participants in 16 statin trials and 501,854 UK Biobank (UKB) participants and quality of life data from national health surveys. Method: We developed a CVD microsimulation model using risk equations for myocardial infarction, stroke, coronary revascularisation, cancer, vascular and nonvascular death, estimated using trial data. We calibrated and further developed this model in the UKB cohort, including further characteristics and a diabetes risk equation, and validated the model in UKB and Whitehall II cohorts. We used the model to predict CVD incidence, life expectancy, quality-adjusted life years (QALYs) and impact of UK guideline-recommended statin treatment across quintiles of socioeconomic deprivation. Results: Age, sex, socioeconomic deprivation, smoking, hypertension, diabetes and cardiovascular events were key CVD risk determinants. Model-predicted event rates corresponded well to observed rates across participant categories. The model projected strong gradients in remaining life expectancy, with 4-to-5 years (5-to-8 QALYs) gaps between the least and most socioeconomically deprived quintiles. Guideline-recommended statin treatment was projected to increase QALYs with larger gains in quintiles of higher deprivation. Conclusions: The study demonstrated the potential of guideline-recommended statin treatment to reduce socioeconomic inequalities. This CVD model is a novel resource for individualised long-term projections of health outcomes and effects of CVD treatments.