Long-term risk assessment increases number of patients eligible for statins

CHICAGO – A 30-year risk threshold doubled the number of patients designated as eligible for statin therapy in primary care, according to findings presented at American Heart Association Scientific Sessions.

In addition, the 30-year risk threshold selects patients who have a greater burden of CV risk factors but are not considered eligible for statins under the current 10-year risk assessment, even though these patients’ risk over 30 years is similar to individuals presently selected for treatment with statins, according to the study results.

Basing statin eligibility on long-term risk has been proposed, but the way in which this strategy should be used – and how it effects clinical practice – is not well understood, according to Fernando H.Y. Cesena, MD, PhD, of the Hospital Israelita Albert Einstein in Sao Paulo, and colleagues. In the present study, the researchers aimed “to propose a strategy for statin eligibility based on the 30-year CV risk and verify how this approach modifies the current American College of Cardiology/American Heart Association guideline recommendation.”

Participants were selected from a pool of individuals who had a routine health screening at a single center in Brazil between January 2015 and December 2016. The study included 3,813 subjects aged 40 to 59 years with an LDL cholesterol level between 70 mg/dL and 189 mg/dL. Patients who had clinical atherosclerotic CVD or diabetes, or were being treated with lipid-lowering agents, were omitted from the study.

Cesena and colleagues measured 10-year atherosclerotic CVD risk with pooled cohort equations; 30-year risk for “hard CV disease” was calculated with equations developed by the Framingham Risk Study. The researchers “determined the 30-year risk thresholds corresponding to the minimum 30-year risk observed in subjects with either [a] 10-year risk [of] 7.5% or 5%.” Patients were eligible for statins according to the 30-year risk criteria if that risk was greater than or equal to the 30-year risk threshold.

The mean age of patients in the study was 47 years (± 5 years); 65% were men.

Compared with patients not classified as eligible for statins according to both the 10-year and 30-year risk scores, patients with a 10-year risk of less than 7.5% and a 30-year risk of greater than or equal to 26.8% were more likely to be men (59% vs. 96%, respectively; P < .01) who were older [median interquartile range, 45 years (42 to 50 years) vs. 50 years (47 to 53 years); P < 0.1). These individuals also had higher LDL cholesterol (120 ± 26 mg/dL vs. 139 ± 26 mg/dL; P < .01), lower HDL cholesterol (51 ± 13 mg/dL vs. 42 ± 9 mg/dL; P < .01), higher triglycerides [median interquartile range, 101 mg/dL (74 to 143 mg/dL) vs. 157 mg/dL (121 to 214 mg/dL); P < .01), higher BMI (26.6 ± 4.2 kg/m² vs. 29.3 ± 4.3 kg/m²; P < .01) and higher systolic blood pressure (116 ± 12 mm Hg vs. 130 ± 13 mm Hg; P < .01).

“Using the 30-year risk thresholds established in this study doubles statin eligibility in primary care,” the researchers wrote. “This approach identifies individuals with [a] higher risk factor burden who are not statin candidates under the 10-year risk assessment but have 30-year risk comparable to those currently recommended for statins and thereby may have similar long-term benefit from the therapy.” - by Julia Ernst, MS

Reference:

Cesena FHY, et al. Abstract Sa1073/1073. Presented at: American Heart Association Scientific Sessions; Nov. 10-12, 2018; Chicago.

Disclosures: Cesena reports receiving research grants from Sanofi. Please see the abstract for all other authors’ relevant financial disclosures.