Using the ACC/ American Heart Association (AHA) risk-based approach for primary prevention of atherosclerotic cardiovascular disease (ASCVD) with statins may be superior to other approaches, according to a study published Dec. 14 in the Journal of the American College of Cardiology.

The study, led by Martin B. Mortensen, MD, PhD, looked at 37,892 patients in the Copenhagen General Population Study who were ages 40 to 75 and were free of ASCVD, diabetes and statin use at baseline. Results showed that after five years, 42 percent were eligible for statin therapy in accordance with the 2013 ACC/AHA risk assessment and cholesterol treatment guideline approach, while 56 percent were eligible using a trial-based approach, and 21 percent were eligible using a hybrid approach.

The authors found that the ACC/AHA-recommended absolute risk score “was well calibrated around the 7.5 percent 10-year ASCVD risk treatment threshold and discriminated better than the trial-based or hybrid approaches.” In addition, compared with the ACC/AHA risk-based approach, the net reclassification index for eligibility for statin therapy within the population was -0.21 for the trial-based approach and -0.13 for the hybrid approach.

“Our results indicate that the ACC/AHA guidelines will prevent more ASCVD events than the trial-based and hybrid approaches; compared with the trial-based approach, it will prevent more ASCVD events by treating fewer people,” the authors conclude.

In a related editorial comment, Vera Bittner, MD, MSPH, FACC, immediate past chair of ACC’s Prevention of Cardiovascular Disease Section Leadership Council, notes that moving forward, “additional research is needed in this area, and ongoing trials with PCSK9 inhibitors will provide important insights in the near future.” She adds that “for now, the 2013 ACC/AHA risk calculator is our best tool to [quantify risk,] and, in the absence of contraindications or patient wishes, we should treat those who fall into the primary prevention statin benefit groups.” 

Keywords: Cardiovascular Diseases, Cholesterol, Diabetes Mellitus, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Primary Prevention, Risk Assessment

< Back to Listings