Using individual age- and sex-specific cardiovascular disease risk thresholds could improve the latest recommendations in 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular (ASCVD) Risk in Adults, according to a study published April 20 in the Journal of the American College of Cardiology.

Using data from the Framingham Offspring Study, researchers compared the current treatment recommendations for 3,685 participants free of cardiovascular disease with varying age- and sex-specific 10-year cardiovascular disease risk thresholds for statin treatment. Participants were divided into subgroups for age (40 – 55, 56 – 65, and >65) and sex, and assessed over 10 years for new-onset cardiovascular disease events, such as nonfatal myocardial infarction, fatal or nonfatal stroke and heart failure.

The results of the study showed that using the current guideline 10-year risk threshold of 7.5 percent, 47 percent of adults met the criteria for statin therapy. However, when the risk threshold was lowered to 5 percent in men and women aged 40 – 55 years old, sensitivity increased from 36 percent to 48 in women, and 48 percent to 71 percent in men, with only a slight reduction in specificity. Further, raising the risk threshold to 15 percent for men aged 66 – 75 reduced the number of men recommended for statin therapy from 97 percent to 89 percent, with no change in sensitivity and an increase in specificity from 3 percent to 14.

The authors note that while the study highlights the need for improved discrimination between patients who do and do not need statin treatment, they underscore the importance that the thresholds in the guidelines are “starting points in a conversation between patients and providers,” with decisions on treatment determined with consideration of the patient’s age and sex.

“The guidelines recommend a clinician-patient risk discussion preceding the statin assignment in which clinical judgment and informed patient preference could be used to individualize the risk decision,” explains Neil J. Stone, MD, FACC, lead author of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce ASCVD Risk in Adults in an accompanying editorial comment. “Decision making does not rely exclusively on fixed thresholds but on coherent actions that help achieve the ultimate strategic goal of ASCVD risk reduction.” 

Keywords: Adult, Cholesterol, Decision Making, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Patient Preference, Research Personnel, Risk, Risk Reduction Behavior, Stroke

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