- Atherosclerotic cardiovascular disease is linked to the buildup of plaque in blood vessels. This can increase the risk of serious cardiovascular events, such as heart attack and stroke.
- Statins are a type of medication that can help people at risk for atherosclerotic cardiovascular disease. Doctors look at several factors to determine whether statin treatment is best for a person.
- The American Heart Association recently updated its risk equations for predicting the risk of cardiovascular disease events.
- A recent study found that use of the latter risk equations could result in a decrease in the number of adults meeting eligibility criteria for statin treatment in primary prevention, which could change clinical practice in this area.
Doctors must make difficult choices about prescribing medications, weighing the potential risks and benefits. They typically use official recommendations from governing bodies and relevant medical organizations to guide their clinical practice recommendations.
Groups update these guidelines based on components such as newly available data. Researchers want to understand how these guideline changes affect clinical practice and medication recommendations.
A study recently published in
The researchers used a weighted sample of 3,785 adults. Results indicated that use of the PREVENT equation set significantly reduced the estimated 10-year average risk of atherosclerotic cardiovascular disease.
Researchers calculated that using the PREVENT equations could also reduce the number of adults meeting eligibility criteria for statin use in primary prevention from 45.4 million to 28.3 million.
The results suggest that major changes could occur in the number of people prescribed statins if the PREVENT equations are used.
As noted by
Several conditions related to cardiovascular atherosclerosis can lead to serious bodily harm, such as heart attacks and strokes.
Sometimes doctors can
Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the structural heart program at MemorialCare Saddleback Medical Center in Laguna Hills, Calif., was not involved in the ongoing research, told Medical news today that “(s)statins are commonly used in clinical practice in two scenarios: in people who have already suffered a cardiovascular event such as a heart attack or stroke, or in people with risk factors for developing a cardiac disease. »
“For people who have already had a heart attack or stroke, we recommend a ‘high-intensity’ statin, such as atorvastatin or rosuvastatin,” he told us.
“For everyone else, the decision to start taking a statin depends on our assessment of their risk of developing cardiovascular disease in the future. This includes an assessment of their risk factors for heart disease, such as high blood pressure and/or diabetes. To help us decide whether someone should start taking a statin, we will frequently use a risk calculator to estimate a person’s 10-year risk of developing cardiovascular disease.
– Cheng-Han Chen, MD
The researchers who conducted the current study explain that the American Heart Association and the American College of Cardiology initially developed pooled cohort equations (PCE) in 2013.
These equations were used to calculate the estimated risk of atherosclerotic cardiovascular disease over 10 years. However, these equations may not be entirely accurate, particularly for groups underrepresented in the initial cohorts that derived the PCEs.
In 2023, the American Heart Association’s Cardiovascular-Kidney-Metabolic Scientific Advisory Group developed a new set of equations to predict the risk of atherosclerotic cardiovascular disease.
This set of equations, the
The current cross-sectional study examined how the PCE and PREVENT equations differ in terms of risk prediction and recommendations for statin treatment in primary prevention.
The researchers used data from the United States National Health and Nutrition Examination Survey (NHANES). They included adults aged 40 to 75 without atherosclerotic cardiovascular disease. The sample size of 3,785 adults was representative of the US population.
The researchers analyzed the data using both sets of equations – PCE and PREVENT equations – to examine the 10-year risk of atherosclerotic cardiovascular disease. However, they did not include data on the social deprivation index as this was not available in the survey data.
They used the 2019 ACC/AHA guidelines to determine eligibility criteria for statin therapy for primary prevention. These guidelines recommend statin therapy for adults aged forty to seventy-five years with diabetes, high cholesterol, or an estimated 10-year atherosclerotic cardiovascular disease risk of 7.5% or greater .
They were then able to calculate the number and proportion of U.S. adults who would experience changes in statin recommendations based on PCEs to PREVENT differences in the equation.
The study found that the estimated 10-year risk of atherosclerotic cardiovascular disease increased from 8% using PCEs to 4.3% using the PREVENT equations.
They observed the most drastic difference for black adults, whose risk fell from 10.9% to 5.1%, and adults between 70 and 75, whose risk fell from 22.8% to 10 .2%. Thus, use of the PREVENT equations could lead to a general shift toward lower risk categories for a number of individuals.
The researchers further estimated that statin recommendations for U.S. adults would decrease from 45.4 million to 28.3 million by switching from PCEs to PREVENT equations. They also noted that many adults eligible to take statins based on the PREVENT equations were not taking statins, which equates to 15.8 million adults.
This research has certain limitations. First, NHANES data relies on self-reporting and not everyone responds to the survey, which can lead to errors.
Data collection also did not note statin dosage, treatment compliance, or changes in HDL cholesterol levels. Additionally, the researchers did not stratify the risk of atherosclerotic cardiovascular disease based on other risk-exacerbating factors, nor did they examine the use of other lipid-lowering treatments.
The researchers included individuals with certain outliers for both calculators, even though clinical practice typically excludes these individuals.
Another problem was that the authors were unable to examine LDL cholesterol levels separately in their main analysis, although they accounted for them in sensitivity analyses. Thus, they may have underestimated statin eligibility at the population level.
The researchers note that they could not determine which risk score is more accurate in current practice. Further studies are therefore needed to determine which risk assessment equations are most useful in clinical practice.
They further note that doctors might consider moving away from precise treatment thresholds and toward better communicating risks with people.
Chen commented that this could also lead to a change in risk thresholds. He explained to MNT that:
“Depending on how future guidelines are written, this could result in fewer patients being recommended statin treatment. As statins are known to be very useful in preventing cardiovascular disease, any future guidelines may need to adjust the risk thresholds we use to initiate statin therapy.
Regular use of PREVENT equations could also mean doctors use additional tests to make recommendations.
Michael Broukhim, MD, a board-certified interventional cardiologist at Providence Saint John’s Health Center in Santa Monica, Calif., who is also not involved in the current research, pointed out that ”
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