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USPSTF guidelines on statin therapy result in fewer referrals

Physicians who adhere to the 2016 U.S. Preventive Services Task Force guidelines are likely referring fewer patients for statin therapy compared with those following the 2013 American College of Cardiology/American Heart Association guidelines, according to results recently published in JAMA.

“In 2013, the American College of Cardiology/American Heart Association guidelines substantially expanded the population eligible for statin therapy by basing recommendations on an elevated 10-year risk of atherosclerotic cardiovascular disease,” Neha J. Pagidipati, MD, MPH, of the Duke Clinical Research Institute, Duke University, and colleagues wrote. “In 2016, the U.S. Preventive Services Task Force released new recommendations for primary prevention statin therapy that increased the estimated [atherosclerotic cardiovascular disease] risk threshold for patients, including those with diabetes, and required the presence of at least one cardiovascular risk factor (ie, hypertension, diabetes, dyslipidemia, or smoking) in addition to elevated risk.”

Pagidipati and colleagues studied data from 3,416 participants of the National Health and Nutrition Examination Survey from 2009-2014. The median weighted age of participants was 53 years, and 53% of the participants were women.

Researchers found that along with the 21.5% (95% CI, 19.3-23.7) of patients who reported currently taking lipid-lowering medication, implementing USPSTF recommendations would be associated with initiating statin therapy in an additional 15.8% (95% CI, 14-17.5) of patients, compared with an additional 24.3% (95% CI,22.3%-26.3%) of patients after implementation of the American College of Cardiology/American Heart Association guidelines. Among the 8.9% of individuals in the primary prevention population who would be recommended for statins by American College of Cardiology/American Heart Association guidelines, but not by USPSTF recommendations, 55% would be adults aged 40 to 59 years with a mean 30-year cardiovascular risk greater than 30%, and 28% would have diabetes.

Multiple factors must be considered when determining which patients should go on statin therapy, the researchers wrote.

“Even though younger individuals have modest short-term CVD risk (7% over 10 years), approximately one-third would be expected to experience a cardiovascular event in the next 30 years. Given that half of all CVD events in men and one-third in women occur before age 65 years, reliance on 10-year [atherosclerotic cardiovascular disease] risk alone may miss many younger individuals who could potentially benefit from long-term statin therapy,” Pagidipati and colleagues wrote. “Alternative approaches to augmenting risk-based cholesterol guidelines, including those that explicitly incorporate potential benefit of therapy, should be considered.” – by Janel Miller

Disclosure: Pagidipati reports no relevant financial disclosures. Please see the study for a full list of the other authors relevant financial disclosures.