New risk calculator could reduce eligibility for statins, BP drugs by 16 million US adults
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Key takeaways:
- Use of a new risk calculator could reduce eligibility for statins and BP drugs by nearly 16 million U.S. adults.
- Unless treatment thresholds change, that could lead to an extra 107,000 CV events over 10 years.
Using the American Heart Association’s new PREVENT risk calculator would mean reducing eligibility for statin and/or antihypertensive therapy by approximately 16 million U.S. adults, researchers reported in JAMA.
The report is consistent with two other studies Healio has reported on. In one, 10-year atherosclerotic CVD risk for people with stage 1 hypertension was substantially lower when estimated with the PREVENT equations compared with the Pooled Cohort Equations (PCEs), which led researchers to suggest using 30-year risk to make antihypertensive medication decisions. In another, 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.
The PREVENT calculator 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.
For the present study, the researchers analyzed 7,765 U.S. adults aged 30 to 79 years (median age, 53 years; 51% women) from the National Health and Nutrition Examination Surveys from 2011 to March 2020.
According to the researchers, using the PREVENT equations instead of the PCEs would reclassify 53% of U.S. adults (95% CI, 51.2-54.8) to a lower AHA/American College of Cardiology risk category but only 0.41% (95% CI, 0.25-0.62) to a higher category.
The number of U.S. adults recommended for primary prevention would drop by approximately 15.8 million, with 14.3 million (95% CI, 12.6-15.9) no longer being recommended for primary prevention with statins and 2.62 million (95% CI, 2.02-3.21) no longer being recommended for antihypertensive medications, the researchers wrote.
Those numbers mean that over 10 years, decreases in eligibility could result in an additional 107,000 heart attacks and strokes, they wrote.
Reconsider treatment thresholds
“Our research lab has long held an interest in CVD and in studying the performance of commonly used clinical risk calculators. CV risk estimation is particularly interesting to us because it functions as a gatekeeper for statins and BP medications, some of the most widely prescribed and important drugs in medicine. We had a sense that any change in how we define risk may have a big impact on important clinical decisions,” James Diao, MD, MPhil, a resident physician at Brigham and Women’s Hospital, told Healio.
“Updating risk estimation has the potential to change recommended care for millions of Americans, with substantial implications for the national incidence of heart attack, stroke and diabetes,” Diao said. “Reconsideration of treatment thresholds has never been more important ... Our data may motivate close monitoring for differential effects on medication prescribing and access.”
‘A thought-provoking analysis’
In a related editorial, Jelani K. Grant, MD, cardiovascular disease fellow at Johns Hopkins Medicine, and colleagues wrote: “This study is a thought-provoking analysis of PREVENT-ASCVD that may stimulate and inform valuable conversation on the evolving landscape of cardiovascular risk assessment. The takeaway should not be that a large proportion of U.S. adults receiving primary prevention will be ineligible for preventive therapies using PREVENT-ASCVD. Rather, the key message is that the establishment of optimal PREVENT-ASCVD risk thresholds for guiding therapy is critical in the development of future guidelines. PREVENT-ASCVD offers a pathway to more accurate and inclusive risk prediction, can be used to motivate sustained lifestyle changes, and can help focus statin and antihypertensive therapy on those most likely to benefit. In the meantime, as a medical community, we can redouble our efforts to implement existing cardiovascular prevention guidelines and thereby address the leading cause of death in the U.S. and globally.”
References:
- Grant JK, et al. JAMA. 2024;doi:10.1001/jama.2024.13247.
- What will the new cardiovascular risk calculator mean for patients? https://hms.harvard.edu/news/what-will-new-cardiovascular-risk-calculator-mean-patients. Published July 29, 2024. Accessed July 29, 2024.
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