A systematic examination of the Pooled Cohort Equations to determine the risk factor levels required to exceed the thresholds outlined in the new ACC/American Heart Association cholesterol guidelines showed that "age continues to be a major driver of risk, which highlights the importance of the clinician-patient discussion before statin therapy is initiated."

Additional Resources 2013 Prevention Guidelines ASCVD Risk Estimator 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

The study was published Sept. 1 in the Journal of the American College of Cardiology and led by Kunal Karmali, MD, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University. Karmali and his team entered continuous risk factor levels in isolation and in specified combinations with the risk tool, and observed that a hypothetical man and woman could reach a clinically relevant 10-year risk threshold greater or equal to 7.5 percent throughout the eligible age spectrum of 40 to 79 years, depending on their associated risk factor burden.

The authors note that they observed "important race-sex interactions with risk factor levels that reflected differential risk for atherosclerotic cardiovascular disease (ASCVD) events, which may be particularly notable given the inclusion of fatal and nonfatal stroke in the endpoint." They add that "the inclusion of diabetes in the equations led to important differences in predicted risk that could influence decision making in younger people with diabetes."

Commenting in an editorial, Michael Farkouh, MD, MSc, FACC, writes, "Overall, the use of this risk calculator will substantially increase the number of all Americans, including women and African Americans, who will be considered potential candidates for statin therapy."

He adds that the new model ultimately provides an opportunity to have an informed discussion with patients. "By beginning at a point of providing our patients with an understanding of their 10-year risk of ASCVD, we then allow the patient to understand the magnitude of the problem and the potential interventions that may lie ahead. No risk calculator is perfect, but we can start with one built on evidence and consensus."

Keywords: Cholesterol, Renal Dialysis, Stroke, Kidney Failure, Chronic, Risk Factors, Diabetes Mellitus, Consensus

< Back to Listings