Study Looks at USPSTF vs. ACC/AHA Guidelines For Statin Therapy

A comparison of the 2016 U.S. Preventive Services Task Force (USPSTF) recommendations for statin therapy and the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, showed that more patients would be recommended for statin therapy under the ACC/American Heart Association (AHA) guidelines, according to a study published April 18 in the Journal of the American Medical Association.

The 2013 ACC/AHA guidelines are based on an elevated 10-year risk of atherosclerotic cardiovascular disease (ASCVD), while the 2016 USPSTF recommendations for primary prevention statin therapy increased the estimated ASCVD risk threshold for patients (including those with diabetes) and required the presence of at least one cardiovascular risk factor (i.e., hypertension, diabetes, dyslipidemia, or smoking), in addition to elevated risk.

The study, by Neha J. Pagidipati, MD, MPH, et al., examined data from the 2009-2014 fasting subsample of the continuous National Health and Nutrition Examination Survey, and looked at 3,416 adults aged 40 to 75 years who were free of cardiovascular disease with triglyceride levels of 400 mg/dL or less. Of these, 747 reported that they were currently taking lipid-lowering medication.

The authors found that full implementation of the USPSTF recommendations would be associated with an incremental increase of 15.8 percent of U.S. adults receiving statin treatment. In contrast, full implementation of the ACC/AHA guidelines would be associated with an incremental increase of 24.3 percent in statin users. The USPSTF and ACC/AHA recommendations for treatment were consistent for 36.9 percent of individuals, while the recommendations for no treatment were consistent for 53.8 percent of individuals.

Results also showed that 8.9 percent of individuals in the primary prevention population would be recommended for statin therapy under the ACC/AHA guidelines but not under the USPSTF recommendations. "Further exploration of those who are recommended to receive statins by the ACC/AHA guidelines but not by the USPSTF recommendations revealed that younger adults (4.9 percent of the primary prevention population) and persons with diabetes (2.5 percent of the primary prevention population) would account for much of this difference," said lead author Michael J. Pencina, PhD.

"Given that half of all [cardiovascular disease] events in men and one-third in women occur before age 65 years, reliance on 10-year ASCVD risk alone may miss many younger individuals who could potentially benefit from long-term statin therapy," adds Pencina. Because of this, the authors conclude that moving forward, "alternative approaches to augmenting risk-based cholesterol guidelines, including those that explicitly incorporate potential benefit of therapy, should be considered."

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

Keywords: Adult, American Heart Association, American Medical Association, Atherosclerosis, Cardiovascular Diseases, Cholesterol, Diabetes Mellitus, Dyslipidemias, Fasting, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Nutrition Surveys, Primary Prevention, Risk Factors, Smoking, Triglycerides


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