Article Text

Evaluating quality and its determinants in lipid control for secondary prevention of heart disease and stroke in primary care: a study in an inner London Borough
  1. Hiten Dodhia1,
  2. Liu Kun2,
  3. Hugh Logan Ellis3,
  4. James Crompton1,
  5. Anthony S Wierzbicki4,
  6. Helen Williams5,
  7. Anna Hodgkinson6,
  8. John Balazs7
  1. 1Lambeth & Southwark Councils, Public Health, London, UK
  2. 2Division of Health and Social Care Research, King's College London, London, UK
  3. 3Kings College NHS Foundation Trust, F2 Doctor, London, UK
  4. 4Department of Chemical Pathology, St Thomas’ NHS Foundation Trust, London, UK
  5. 5NHS Southwark Clinical Commissioning Group, Medicines Management Team, London UK
  6. 6NHS Lambeth Clinical Commissioning Group, Medicines Management Team, London, UK
  7. 7NHS Lambeth Clinical Commissioning Group, Governing Body Member, London, UK
  1. Correspondence to Dr Hiten Dodhia; hiten.dodhia{at}


Objectives To assess quality of management and determinants in lipid control for secondary prevention of cardiovascular disease (CVD) using multilevel regression models.

Design Cross-sectional study.

Setting Inner London borough, with a primary care registered population of 378 000 (2013).

Participants 48/49 participating general practices with 7869 patients on heart disease/stroke registers were included.

Outcome measures (1) Recording of current total cholesterol levels and lipid control according to national evidence-based standards. (2) Assessment of quality by age, sex, ethnicity, deprivation, presence of other risks or comorbidity in meeting both lipid measurement and control standards.

Results Some process standards were not met. Patients with a current cholesterol measurement >5 mmol/L were less likely to have a current statin prescription (adjusted OR=3.10; 95% CI 2.70 to 3.56). They were more likely to have clustering of other CVD risk factors. Women were significantly more likely to have raised cholesterol after adjustment for other factors (adjusted OR=1.74; 95% CI 1.53 to 1.98).

Conclusions In this study, the key factor that explained poor lipid control in people with CVD was having no current prescription record of a statin. Women were more likely to have poorly controlled cholesterol (independent of comorbid risk factors and after adjusting for age, ethnicity, deprivation index and practice-level variation). Women with CVD should be offered statin prescription and may require higher statin dosage for improved control.

  • health care equity

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.