Comparison of Statin Eligibility by USPSTF and ACC/AHA Criteria

Study Questions:

What is the difference in eligibility for primary prevention statin treatment among US adults, assuming full application of United States Preventive Services Task Force (USPSTF) recommendations compared with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines?

Methods:

The investigators used data from the National Health and Nutrition Examination Survey (NHANES, 2009-2014) to assess statin eligibility under the 2016 USPSTF recommendations versus the 2013 ACC/AHA cholesterol guidelines among a nationally representative sample of 3,416 US adults aged 40-75 years with fasting lipid data and triglyceride levels of ≤400 mg/dl, without prior cardiovascular disease. The main outcome measure was eligibility for primary prevention statin therapy. The authors determined the proportion of adults eligible for statin therapy under each recommendation following NHANES analytic guidelines, using sample weights to account for the complex multistage probability-sampling design.

Results:

Among the US primary prevention population represented by 3,416 individuals in NHANES, the median weighted age was 53 years (interquartile range, 46-61 years), and 53% (95% confidence interval [CI], 52%-55%) were women. Along with the 21.5% (95% CI, 19.3%-23.7%) of patients who reported currently taking lipid-lowering medication, full implementation of the USPSTF recommendations would be associated with initiation of statin therapy in an additional 15.8% (95% CI, 14.0%-17.5%) of patients, compared with an additional 24.3% (95% CI, 22.3%-26.3%) of patients who would be recommended for statin initiation under full implementation of the 2013 ACC/AHA guidelines. Among the 8.9% of individuals in the primary prevention population who would be recommended for statins by ACC/AHA guidelines, but not by USPSTF recommendations, 55% would be adults aged 40-59 years with a mean 30-year cardiovascular risk >30%, and 28% would have diabetes.

Conclusions:

The authors concluded that adherence to the 2016 USPSTF recommendations for statin therapy, compared with the ACC/AHA guidelines, could lead to fewer individuals recommended for primary prevention statin therapy.

Perspective:

This study reports that adherence to the 2016 USPSTF recommendations for statin therapy, compared with the 2013 ACC/AHA guidelines, could lead to fewer individuals recommended for primary prevention statin therapy, including many younger adults with high mean long-term cardiovascular disease risk. If the study estimates are accurate and assuming these proportions can be projected to the US population, there could be an estimated 17.1 million versus 26.4 million US adults with a new recommendation for statin therapy, based on the USPSTF recommendations versus the ACC/AHA guideline recommendations, respectively—an estimated difference of 9.3 million individuals. Additional studies are indicated to assess potential risks versus benefits of statin therapy in these 9.3 million individuals.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Cholesterol, Diabetes Mellitus, Dyslipidemias, Guideline Adherence, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipids, Metabolic Syndrome X, Outcome Assessment (Health Care), Practice Guidelines as Topic, Primary Prevention, Risk Factors, Triglycerides


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