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Individualized benefit approach expands statin eligibility
A new individualized benefit approach to prescribing statins has identified approximately 9.5 million lower-risk Americans who could benefit from statin therapy as a primary prevention of CVD, researchers reported in Circulation.
“Our study is changing the way we think about prescribing statins; we should not only be considering who is at risk of heart disease but, more importantly, who would benefit from these medications,” George Thanassoulis, MD, MSc, director of preventive and genomic cardiology at the McGill University Health Centre in Montreal and an associate professor in medicine at McGill University, said in a press release. “These individuals were lower risk because they were younger, but they also had higher levels of [LDL] cholesterol, which we have known to be an important cause of heart disease. Targeting statin treatment to this group would prevent an additional 266,000 [MIs] and strokes over 10 years.”
George Thanassoulis
Thanassoulis and colleagues compared the current 10-year risk-based approach with a new individualized benefit approach using data from 2,134 participants in the National Health and Nutrition Examination Survey.
The risk-based approach follows the 2013 American College of Cardiology/American Heart Association guidelines that recommend statin therapy for men and women with a 10-year pooled cohort equations risk of more than 7.5% and LDL cholesterol of at least 70 mg/dL. The individualized benefit approach is an integration of predicted risk and RR reductions of at least 2.3% from randomized trials.
Although the risk-based approach identified 15 million Americans as eligible for statin therapy, the benefits-based approach indicated that 24.6 million Americans could benefit from the medication.
These additional Americans were younger (mean age, 55.2 years vs. 62.5 years; P < .001 for benefit-based vs. risk-based) and had a higher LDL cholesterol (140 mg/dL vs. 133 mg/dL; P = 0.01) than individuals with higher risks.
Sensitivity analysis suggested that using a higher statin potency would increase the number of eligible participants to 28.3 million Americans.
The researchers wrote that their data suggests that statin benefit should not just be based on 10-year risk, but on risk, LDL levels and statin potency. They said their findings “may help develop guideline recommendations that better identify individuals who meaningfully benefit from statin therapy.”
“This strategy will transform [CV] prevention for the better,” Allan Sniderman, MD, McGill University Health Center cardiologist and full professor in medicine at McGill University, said in the release. “For too many, the present approach starts too late; an earlier start will multiply the lives saved.” – by Tracey Romero
Disclosure : The researchers report no relevant financial disclosures.