Choosing Between Guidelines: Statins for Primary CVD Prevention
Clinical guidelines on the initiation of statin therapy to prevent atherosclerotic cardiovascular disease (ASCVD) are published by several professional societies. A recent review1 compared 2 prominent sets of recommendations,2,3 applying guidance from each to a nationally representative US population. They found that approximately 15% (~16.0 million) fewer adults would be eligible for statin therapy for primary prevention under 2022 recommendations from the United States Preventive Services Task Force2 compared to the 2018 recommendatios from the American Heart Association/American College of Cardiology/ Multisociety consortium.3 Following is a Patient Care® Guideline Topline summary of what the authors found.
THE POPULATION: Ambulatory, non-pregnant US adults aged 40–75 years with LDL-C <190 mg/dL and no prevalent ASCVD from the National Health and Nutrition Examination Survey 2017–2020 (N=1799)
Clinical guidelines on statin initation from the United States Preventive Services Task force and the American Heart Association/American College of Cardiology/Mutlisociety consortium.
Study population drawn from the National Health and Nutrition Examination Survey (NHANES) 2017-2020.
Eligibility for statin therapy was approximately 15% less based on USPSTF criteria vs AHA/ACC/MS criteria.
Eligibility for statin therapy was lower in both age groups studied using USPSTF criteria vs criteria from the AHA/ACC/MS guideline.
Fewer individuals were eligible for statin therapy according to the USPSTF criteria vs the AHA/ACC/MS criteria and those who were not eligilbe tended to be younger and had shorter disease duration.
USPSTF 3 principal recommendations for initiating statin therapy for primary prevention.
The executive summary of the AHA/ACC/MS guidelines on initiation of statin therapy for primary prevention offers 10 "take aways" on the guideline recommendations. Above, take aways 1-4.
AHA/ACC/MS take aways 5-7 on statin initiation in adults aged 40-75 yrs.
AHA/ACC/MS take aways 8 & 9 on statin initiation in adults aged 40-75 yrs.
AHA/ACC/MS take away #10 recommends assessing response to statin therapy with repeated lipid measurements, comparing successive measures to baseline measures.
When LDL-C and 10-year % ASCVD risk not definitive for initiating statin therapy, ordering a coronary artery calcium test is recommended.
Any decision to initiate statin therapy must be based on a clinician-patient discussion of risks and benefits: "This frank discussion...should consider whether ASCVD risk factors have been addressed, evaluate whether an optimal lifestyle has been implemented, and review the potential for statin benefit versus the potential for adverse effects and drug-drug interactions."
