When Statin Guidelines Collide: 5 Questions on 2 Approaches to Primary CVD Prevention
Guidelines on primary ASCVD prevention from the USPSTF and the AHA/ACC/Multisociety differ on why and when to initiate a statin. Try the 5-question quiz.
Clinical guidelines on the primary prevention of atherosclerotic cardiovascular disease (ASCVD) from the United States Preventative Services Taskforce (USPSTF; 2022)1 and the American Heart Association/American College of Cardiology/Multisociety ( AHA/ACC/MS; 2018),2 are 2 of the leading resources for evidence-based recommendations on how to mitigate risk of a first CVD event. They differ, however, in the risk factors that suggest and level of risk at which a statin should be initiated.
The following 5 questions test what you know about the differences and the benefit-risk balance of statin therapy.
1. Which guideline/s recommend/s a statin for the population identified?
Answer: The AHA/AC/MS guideline recommends statin therapy for a larger population considered to be at risk for ASCVD vs the USPSTF.
2. When a decision to initiate a statin based on specified risk factors (LDL-C, 10-year x% ASCVD risk) remains uncertain, which guideline/s recommend a CAC test to provide further guidance?
Answer: B. AHA/ACC/MS guidelines on primary CVD prevention recommend obtaining a CAC value to help further stratify a person's risk.
3. Which of the statements above on AHA/ACC/MS- recommended use of a CAC test is False?
Answer: Option A is false -- per the AHA/ACC/MS guidelines, if a CAC score is zero, treatment may be withheld or delayed except in the risk groups mentioned.
4. Match the side effects of statin therapy above with their evidence-based frequency.
Answer: While statin-associated muscle symptoms occur infrequently (1% to 5%), myositis/myopathy, rhabdomyolysis, and statin-associated autoimmune myopathy occur only rarely.
5. Which of the diabetes-specific risk factors above should tip the balance in favor of recommending a statin or intensifying a statin regimen (per the AHA/ACC/MS guideline)?
Answer: A. Retinopathy or neuropathy. The AHA/ACC/MS guideline on primary CVD prevention suggests >10 years duration for T2D and >20 years duration for T1D when considering initiating a statin.
