- Atherosclerotic cardiovascular disease is associated with the buildup of plaque in blood vessels. It can increase the risk of serious cardiovascular events, such as heart attack and stroke.
- Statins are a type of medication that can help people who are at risk for atherosclerotic cardiovascular disease. Doctors consider several factors to determine whether statin therapy makes the most sense for a patient.
- The American Heart Association recently updated its risk equation for predicting the risk of developing cardiovascular disease.
- Recent studies have found that use of these updated risk equations may result in fewer adults meeting eligibility criteria for primary prevention statin therapy, potentially changing clinical practice in this area.
Physicians must make difficult choices about whether to prescribe a medication, weighing the potential risks and benefits. Physicians typically use official recommendations from governing bodies and relevant medical organizations to guide their clinical practice recommendations.
The group will update these guidelines based on newly available data and other factors, and researchers hope to understand how changes to these guidelines will affect clinical practice and medication recommendations.
Recently published studies
The researchers used a weighted sample of 3,785 adults, and their results showed that using one set of equations, PREVENT, significantly reduced the estimated 10-year average risk of atherosclerotic cardiovascular disease.
The researchers calculated that using the PREVENT equation could also reduce the number of adults meeting eligibility criteria for primary prevention statin use from 45.4 million to 28.3 million.
The results suggest that using the PREVENT equation could result in significant changes in the number of people prescribed statins.
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Some atherosclerotic cardiovascular disease-related conditions can lead to serious physical damage, such as heart attack or stroke.
Sometimes, doctors
“The results are encouraging,” explained 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, California, who was not involved in the current study. Today’s Medical News that “[s]In clinical practice, tatins are often used in two scenarios: in people who already have cardiovascular disease, such as a heart attack or stroke, or in people who have risk factors for developing heart disease.”
“For people who have already had a heart attack or stroke, we recommend a ‘high-intensity’ statin such as atorvastatin or rosuvastatin,” he said.
“For everyone else, the decision whether to start a statin is driven by an assessment of their risk of developing cardiovascular disease in the future. This includes an assessment of risk factors for heart disease such as high blood pressure and diabetes. To decide whether to start a statin, we often use risk calculators to estimate their 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 first developed the Pooled Cohort Equation (PCE) in 2013.
These equations were useful for calculating 10-year risk estimates for atherosclerotic cardiovascular disease, although they may not be completely accurate, especially for groups that were underrepresented in the original cohort from which the PCE was derived.
In 2023, the American Heart Association’s Cardiovascular, Renal and Metabolic Science Advisory Group developed a new set of equations to predict risk of atherosclerotic cardiovascular disease.
This set of equations is:
In the current cross-sectional study, we examined how the PCE and PREVENT equations differ in risk prediction and recommendations for primary prevention statin therapy.
The researchers used data from the US National Health and Nutrition Examination Survey (NHANES), which included adults aged 40 to 75 years who were free of atherosclerotic cardiovascular disease. The sample size was 3,785 adults, which was representative of the US population.
The researchers analyzed the data using both groups of equations, the PCE equation and the PREVENT equation, to examine 10-year atherosclerotic cardiovascular disease risk, but did not include data on the social deprivation index, as this was not available in the survey data.
They determined eligibility criteria for primary prevention statin therapy using the 2019 ACC/AHA guidelines, which recommend statin therapy for adults aged 40 to 75 years with diabetes, high cholesterol levels, or an estimated 10-year risk of atherosclerotic cardiovascular disease of 7.5% or higher.
The researchers were then able to calculate the number and percentage of U.S. adults who would experience a change in statin recommendation based on the difference in PCE to PREVENT equation.
The study found that the estimated 10-year risk of atherosclerotic cardiovascular disease decreased from 8% using the PCE to 4.3% using the PREVENT equation.
The most dramatic changes were seen among black adults, whose risk decreased from 10.9% to 5.1%, and among adults aged 70 to 75 years, whose risk decreased from 22.8% to 10.2%. Thus, use of the PREVENT equation may lead to many individuals moving into an overall lower-risk category.
The researchers further estimated that switching from PCE to the PREVENT equation would reduce statin recommendations for U.S. adults from 45.4 million to 28.3 million. They also noted that many adults who would be eligible to take statins under the PREVENT equation are not taking them — 15.8 million people.
This study has several limitations. First, NHANES data are based on self-reporting, which can lead to errors because not everyone responds to the survey.
The data collection did not address statin dosage, adherence, or changes in HDL cholesterol levels. Additionally, the researchers did not stratify risk of atherosclerotic cardiovascular disease by other risk-increasing factors or examine the use of other lipid-lowering therapies.
The researchers included certain outlier individuals in both formulas, although such individuals would typically be excluded in clinical practice.
Another issue is that although the authors took LDL cholesterol levels into account in a sensitivity analysis, they were unable to examine it separately in the primary analysis, and therefore may have underestimated statin eligibility at the population level.
The researchers note that they were unable to determine which risk score is most accurate in current practice and that further research is needed to determine which risk assessment equation would be most useful in clinical practice.
Furthermore, they note that physicians could consider shifting from setting precise treatment thresholds to better risk communication with patients.
Chen commented that this could also lead to a shift in risk thresholds. MNT that:
“Depending on how future guidelines are written, it is possible that fewer patients will be recommended statin therapy. Because statins are known to be very effective in preventing cardiovascular disease, future guidelines may need to adjust the risk thresholds used for initiating statin therapy.”
Regular use of the PREVENT equation also allows doctors to make recommendations using additional testing.
“This is a very interesting study,” said Dr. Michael Bulkim, a board-certified interventional cardiologist at Providence Saint John’s Health Center in Santa Monica, California, who was not involved in the study.[t]The potential clinical impact is that fewer patients receiving treatment for hyperlipidemia may result in increased cardiovascular and cerebrovascular events.”
“Utilizing additional testing, such as coronary artery calcium scoring and lipoprotein A testing, may become more important in determining whether a patient would benefit from statin therapy,” he advised.