Although cardiovascular disease (CVD), including heart attacks and strokes, is still the leading cause of death in the UK, the risk of CVD events and death can be reduced by identifying and treating major risk factors such as high blood pressure (BP), lipids (e.g. cholesterol), and fasting blood glucose (FBG) / haemoglobin A1c (HbA1c, marker for average blood glucose levels of last 3 months, widely used by doctors). Due to the COVID-19 pandemic, access to routine clinical care was dramatically disrupted during 2020. This led to changes in the patterns of attendance in primary care from March 2020 onwards, which in turn significantly altered patterns of drug prescribing and dispensing, including for cardiovascular drugs. Clinical observation has shown that an increasing number of people had risk factors, such as high body mass index (BMI) and BP, high cholesterol or triglyceride levels, and poor liver function markers, during the pandemic. The extent to which this occurred in the population and has had a lasting impact on some people’s risk factor trajectories is still unknown.
Although these changes in practice are likely to have had an influence on the nature of testing, treatment and control of major risk factors for CVD, the extent and potential impact of these changes is unknown. We propose to use routine healthcare records to examine patterns of BMI measurement, BP, lipid, HbA1c and liver function (ALT, AST, GGT) testing in the general population and evidence for control of these risk factors (according to expert clinical guideline recommendations) in patients with CVD and at high risk of developing CVD.
We will also examine whether differences in the quality of testing, diagnosis and control of risk factors are related to any particular patient characteristics (e.g. sex, area-based deprivation indices, ethnicity, common chronic conditions). Finally, we will compare the level of these risk factors during the pandemic with those in 2014-2019.
This work will be undertaken in close alignment with another approved CVD-COVID-UK project, examining changes in CVD drug prescribing during the same period. Considered together, these analyses will provide important insights into the potential impact of the COVID-19 pandemic on the detection and control of key changeable CVD risk factors in the UK population. Outputs from these analyses will be used to model the potential consequences for future CVD events in the UK and help to identify where efforts could potentially be focused most effectively to address emerging gaps in the provision of preventive care.