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Many older Europeans would be statin-eligible under new ACC/AHA guidelines
Most adults in Europe aged at least 55 years would be eligible for statins based on the American College of Cardiology/American Heart Association guidelines, according to a recent study.
Researchers applied the ACC/AHA, Adult Treatment Panel III (ATP III) and the European Society of Cardiology guidelines to a cohort of 4,854 individuals enrolled in the Rotterdam Study, a population-based cohort study of individuals aged 55 years and older in the Netherlands.
The current analysis incorporated data from the third examination of the original Rotterdam Study cohort, recruited between 1997 and 1999, and the first examination of the extended cohort, recruited from 2000 to 2001. The cohort had a mean age of 65.5 years and included 2,209 men and 2,645 women.
The primary outcomes were hard atherosclerotic CVD, defined as fatal or nonfatal MI, other CHD-related death and stroke; hard CHD, including fatal and nonfatal MI and CHD mortality; and atherosclerotic CVD mortality. Patients were followed for events until Jan. 1, 2012.
Under the ACC/AHA guidelines, statins would be recommended for 96.4% of men and 65.8% of women within the cohort vs. 52% of men and 35.5% of women under the ATP-III guidelines, and 66.1% of men and 39.1% of women under the ESC guidelines. Treatment with statins would be “considered” for 3.3% of men and 14.2% of women under the ACC/AHA guideline; 14.2% of men and 14.1% of women under the ATP-III guideline, and 31.6% of men and 51.4% of women under the ESC guideline.
In an analysis of 1,515 men and 1,920 women assessed for risk prediction for atherosclerotic CVD under the ACC/AHA model, researchers reported a projected prevalence of 21.5% among men and 11.6% among women vs. actual cumulative observed rates of 12.7% and 7.9%, respectively. Both the ATP-III and ESC predictive models yielded similar overestimations.
“With application of the recent ACC/AHA guidelines in a healthy European, population-based cohort, nearly all men and the majority of women aged 55 years and older were candidates for drug treatment,” the researchers wrote. “Application of the ACC/AHA, ATP-III and ESC risk prediction models led to overestimation of the risk. Given the modest discrimination and poor calibration of the ACC/AHA risk prediction model, the choice of treatment threshold becomes central.”
Disclosure: See the full study for a list of relevant financial disclosures.