Fewer US adults suggested for statin therapy for primary prevention by new risk calculator
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Key takeaways:
- In the new PREVENT heart disease risk calculator, fewer U.S. adults were eligible for primary prevention statin therapy vs. an older calculator.
- However, many people eligible for statins are not taking them.
Fewer U.S. adults aged 40 to 75 years are eligible for statin therapy for primary CVD prevention in the new PREVENT risk calculator compared with the older Pooled Cohort Equation, researchers reported.
However, many people deemed eligible by PREVENT for statins for primary prevention are not taking them, according to the researchers.
“We don’t want people to think they were treated incorrectly in the past,” Timothy Anderson, MD, MAS, a primary care physician at University of Pittsburgh Medical Center and health services researcher and assistant professor of medicine at the University of Pittsburgh, said in a press release. “They were treated with the best data we had when the [Pooled Cohort Equation] was introduced back in 2013. The data have changed.”
As Healio previously reported, the PREVENT calculator, unveiled in November by the American Heart Association, was derived from real-world contemporary datasets including more than 6 million adults and includes HF risk in addition to risk for MI and stroke; omits race from CVD clinical care algorithms; includes kidney function on top of traditional CVD risk factors for heart disease; and includes components such as social determinants of health, blood glucose and kidney function, when clinically available.
Source: UPMC/John Dillard
Anderson and colleagues analyzed a weighted sample of 3,785 U.S. adults (mean age, 56 years; 53% women; 20.7% with current statin use) who participated in the National Health and Nutrition Examination Survey from 2017 to March 2020 and were free from atherosclerotic CVD at baseline.
The mean estimated 10-year ASCVD risk was 8% (95% CI, 7.6-8.4) using the Pooled Cohort Equations (PCEs) and 4.3% (95% CI, 4.1-4.5) using the PREVENT equations, according to the researchers.
In addition, the mean estimated 10-year ASCVD risk was lower using the PREVENT equations than using the PCEs across all age, sex and racial subgroups, with the biggest differences in Black adults (PCE, 10.9%; PREVENT, 5.1%) and people aged 70 to 75 years (PCEs, 22.8%; PREVENT, 10.2%), Anderson and colleagues wrote.
The researchers determined that using the PREVENT equation instead of the PCEs could reduce the number of U.S. adults eligible for statin therapy as primary prevention from 45.4 million to 28.3 million, and that of the 17.3 million people no longer deemed eligible for statin therapy, 4.1 million are currently taking statins.
Among U.S. adults eligible for statin therapy for primary prevention according to PREVENT, 44.1% (95% CI, 38.6-49.5) reported taking statins, translating to 15.8 million (95% CI, 13.4-18.2) U.S. adults who are eligible for statin therapy for primary prevention but are not taking a statin.
“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” Anderson said in the release. “For a patient who we now know is at lower risk than we previously thought, if we recommend they stop taking statins, they still could be back to a higher risk 5 years down the road, for the simple reason that everybody’s risk goes up as we get older.”
Reference:
- Statins for heart disease prevention could be recommended for far fewer Americans if new risk equation is adopted. https://www.upmc.com/media/news/061024-statins-for-heart. Published June 10, 2024. Accessed June 12, 2024.
Perspective
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Michael Miller, MD, FACC, FAHA
The new PREVENT calculator is a more accurate and reliable tool for heart disease risk assessment as compared to the PCE. The updated PREVENT calculator represents an important advance in CVD risk prediction. In addition to being tested in 3 million Americans vs. 30,000 for PCE, it includes assessment of kidney function and A1c, important biomarkers of risk (and absent in PCE).
Notwithstanding age that remains the most important predictor in these risk assessment tools, I think the updated PREVENT calculator will help to identify patients most likely to benefit from statin therapy while excluding others less likely to require them.
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