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

Disease areas:

• heart and blood vessels

Last updated:

2 July 2025

Author(s):

Runguo Wu, Claire Williams, Junwen Zhou, Iryna Schlackow, Jonathan Emberson, Christina Reith, Anthony Keech, John Robson, Jane Armitage, Alastair Gray, John Simes, Colin Baigent, Borislava Mihaylova, CTT Collaboration secretariat, Jane Armitage, Colin Baigent, Elizabeth Barnes, Lisa Blackwell, Rory Collins, Kelly Davies, Jonathan Emberson, Jordan Fulcher, Heather Halls, William G Herrington, Lisa Holland, Anthony Keech, Adrienne Kirby, Borislava Mihaylova, Rachel O'Connell, David Preiss, Christina Reith, John Simes, Kate Wilson, CTT Collaboration trialists: A to Z trial, Michael Blazing, Eugene Braunwald, James de Lemos, Sabina Murphy, Terje R Pedersen, Marc Pfeffer, Harvey White, Stephen Wiviott, AFCAPS/TEXCAPS, Michael Clearfield, John R Downs, Antonio Gotto, Stephen Weis, ALERT, Bengt Fellström, Hallvard Holdaas, Alan Jardine, Terje R Pedersen, ALLHAT, David Gordon, Barry Davis, Curt Furberg, Richard Grimm, Sara Pressel, Jeffrey L Probstfield, Mahboob Rahman, Lara Simpson, ALLIANCE, Michael Koren, ASCOT, Björn Dahlöf, Ajay Gupta, Neil Poulter, Peter Sever, Hans Wedel, ASPEN, Robert H Knopp, AURORA, Stuart Cobbe, Bengt Fellström, Hallvard Holdaas, Alan Jardine, Roland Schmieder, Faiez Zannad, CARDS, D John Betteridge, Helen M Colhoun, Paul N Durrington, John Fuller, Graham A Hitman, Andrew Neil, CARE, Eugene Braunwald, Barry Davis, C Morton Hawkins, Lemuel Moyé, Marc Pfeffer, Frank Sacks, CORONA, John Kjekshus, Hans Wedel, John Wikstrand, 4D, Christoph Wanner, Vera Krane, GISSI Heart Failure and Prevention trials, Maria Grazia Franzosi, Roberto Latini, Donata Lucci, Aldo Maggioni, Roberto Marchioli, Enrico B Nicolis, Luigi Tavazzi, Gianni Tognoni, HOPE-3, Jackie Bosch, Eva Lonn, Salim Yusuf, HPS, Jane Armitage, Louise Bowman, Rory Collins, Anthony Keech, Martin Landray, Sarah Parish, Richard Peto, Peter Sleight, IDEAL, John JP Kastelein, Terje R Pedersen, JUPITER, Robert Glynn, Antonio Gotto, John JP Kastelein, Wolfgang Koenig, Jean MacFadyen, Paul M Ridker, LIPID, Anthony Keech, Stephen MacMahon, Ian Marschner, Andrew Tonkin, John Shaw, John Simes, Harvey White, LIPS, Patrick W Serruys, Post-CABG, Genell Knatterud, PROSPER, Gerard J Blauw, Stuart Cobbe, Ian Ford, Peter Macfarlane, Chris Packard, Naveed Sattar, James Shepherd, Stella Trompet, PROVE-IT, Eugene Braunwald, Christopher P Cannon, Sabina Murphy, SEARCH, Rory Collins, Jane Armitage, Louise Bowman, Richard Bulbulia, Richard Haynes, Sarah Parish, Richard Peto, Peter Sleight, SPARCL, Pierre Amarenco, K Michael Welch, 4S, John Kjekshus, Terje R Pedersen, Lars Wilhelmsen, TNT, Philip Barter, Antonio Gotto, John LaRosa, John JP Kastelein, James Shepherd, WOSCOPS, Stuart Cobbe, Ian Ford, Sharon Kean, Peter Macfarlane, Chris Packard, Michele Roberston, Naveed Sattar, James Shepherd, Robin Young, Other CTT Collaboration members, Hiroyuki Arashi, Robert Clarke, Marcus Flather, Shinya Goto, Uri Goldbourt, Jemma Hopewell, G Kees Hovingh, George Kitas, Connie Newman, Marc S Sabatine, Gregory G Schwartz, Liam Smeeth, Jonathan Tobert, John Varigos, Junichi Yamamguchi

Publish date:

27 September 2023

Journal:

British Journal of General Practice

PubMed ID:

38373851

DOI:

10.3399/bjgp.2023.0198

Abstract

BACKGROUND: UK cardiovascular disease (CVD) incidence and mortality have declined in recent decades but socioeconomic inequalities persist.

AIM: To present a new CVD model, and project health outcomes and the impact of guideline-recommended statin treatment across quintiles of socioeconomic deprivation in the UK.

DESIGN AND SETTING: A lifetime microsimulation model was developed using 117 896 participants in 16 statin trials, 501 854 UK Biobank (UKB) participants, and quality-of-life data from national health surveys.

METHOD: A CVD microsimulation model was developed using risk equations for myocardial infarction, stroke, coronary revascularisation, cancer, and vascular and non-vascular death, estimated using trial data. The authors 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. The model was used to predict CVD incidence, life expectancy, quality-adjusted life years (QALYs), and the impact of UK guideline-recommended statin treatment across socioeconomic deprivation quintiles.

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 4-5-year (5-8 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.

CONCLUSION: 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 of CVD treatments.