If the new risk equation is adopted, far fewer Americans may be recommended statins to prevent heart disease.

If national guidelines were revised to incorporate the new risk equation, roughly 40% fewer people could meet the criteria for cholesterol-lowering statins to prevent heart disease, according to a study by researchers at the University of Pittsburgh, Beth Israel Deaconess Medical Center and the University of Michigan.

Publishing JAMA Internal MedicineThe study explores the potential impact of widespread adoption of the PREVENT equation, released by the American Heart Association in November 2023 to update doctors’ go-to calculation tool for assessing a patient’s 10-year risk of heart attack or stroke.

At the population level, the number of adults recommended to take statins could fall from 45.4 million to 28.3 million. At the same time, the survey found that most of those recommended to take statins are not currently taking them.

“This is an opportunity to refocus our efforts and put resources on the patient populations that are most at risk,” said lead author Timothy Anderson, MD, MAS, a primary care physician at UPMC and a health services researcher and assistant professor of medicine at the University of Pittsburgh.

For their analysis, the research team used nationally representative data from 3,785 adults aged 40 to 75 years who participated in the National Health and Nutrition Examination Survey from January 2017 to March 2020. The researchers estimated the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the Prediction of Risk of Cardiovascular Disease Events (PREVENT) equation and compared their results to risks estimated using an earlier tool known as the Pooled Cohort Equation (PCE).

Because the PCE equation was based on decades-old patient data and lacked diversity, the PREVENT equation was developed by the American Heart Association to more accurately represent risk across the current U.S. population.

PREVENT also reflects recent findings on the biology of ASCVD: current statin use, metabolic disease, and renal disease are incorporated into the new calculation, but race is excluded from the calculation, reflecting the growing recognition that race is a social construct.

Using PREVENT, the team found that the 10-year risk of incident ASCVD in the overall study population was 4%, half the risk calculated by PCE (8%), with the difference being even larger for black adults (5.1% vs. 10.9%) and adults aged 70 to 75 years (10.2% vs. 22.8%).

Of patients currently taking statins, an estimated 4.1 million will no longer be recommended to take them under PREVENT. Clear and careful communication is key for these patients and their doctors, Anderson said. “We don’t want people to feel like they were mistreated in the past. They were treated based on the best data we had at the time PCE was introduced in 2013. The data is changing.”

At the same time, he adds, it’s important to recognize that everyone’s risk inevitably changes over time: “If you encourage a patient to stop taking statins because you know they’re at lower risk than you previously thought, five years later they may be at higher risk again, for the simple reason that risk increases as you get older.”