The American College of Cardiology/American Heart Association guidelines for preventive statin therapy would cover an estimated 9.3 million more U.S. adults than would the U.S. Preventive Services Task Force guidelines, according to a report published online April 18 in JAMA.
Most of this difference can be attributed to younger adults and those with diabetes, for whom the ACC/AHA guidelines recommend statin therapy but the USPSTF guidelines do not, said Neha J. Pagidipati, MD, of the Duke Clinical Research Institute, Durham, N.C., and her associates.
They compared the proportion of patients who would be eligible for primary prevention statin therapy according to these two sets of guidelines by applying the eligibility criteria to a sample of 3,416 participants in the nationally representative 2009-2014 National Health and Nutrition Examination Survey (NHANES). These participants were 40-75 years of age, were free of cardiovascular disease, and had triglyceride levels of 400 mg/dL or less. A total of 747 (21.5%) were taking lipid-lowering medication at the time of the survey.
If the USPSTF guidelines ( JAMA. 2016 Nov 15;316:1997-2007)were fully implemented in this cohort, 15.8% more of the participants would be taking statin therapy. In contrast, if the ACC/AHA guidelines (Circulation. 2014 Jun 24;129[25 Suppl 2]:S1-4) were fully implemented in this cohort, 24.3% more would be taking statins.
A total of 8.9% of the cohort would be recommended for statin therapy under the ACC/AHA guidelines but not the USPSTF guidelines. Most of this discrepancy could be attributed to the youngest adults and to those with diabetes. The ACC/AHA guidelines were much more likely to recommend statins to patients aged 40-59 years. Such patients have a relatively low 10-year risk of cardiovascular events (7.0%) but a much higher longer-term risk of 34.6% at 30 years, the investigators said.
“Given that half of all [cardiovascular] events in men and one-third in women occur before age 65 years, reliance on 10-year risk alone may miss many younger individuals who could potentially benefit from long-term statin therapy,” they noted (JAMA 2017 Apr 18. doi: 10.1001/jama.2017.3416).
Further analysis broke down which adults the ACC/AHA guidelines covered, in contrast to the USPSTF guidelines: younger male smokers, younger men with dyslipidemia, younger men with high LDL-cholesterol levels, younger women with obesity, and older men who didn’t have high LDL-cholesterol levels.
Extrapolating these findings to the general U.S. population, “there could be an estimated 17.1 million vs 26.4 million U.S. adults with a new recommendation for statin therapy, based on the USPSTF recommendations vs the ACC/AHA guideline recommendations, respectively – an estimated difference of 9.3 million individuals,” Dr. Pagidipati and her associates wrote.
“Alternative approaches to augmenting risk-based cholesterol guidelines, including those that explicitly incorporate potential benefit of therapy, should be considered,” they added.
This study was supported by the Duke Clinical Research Institute. Dr. Pagidipati reported having no relevant financial disclosures; her associates reported ties to numerous industry sources.
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