If American Heart Association guidelines passed in November 2023 are widely adopted, about 40% fewer people would meet the criteria to be on statins, a new study shows.
The Predicting Risk of Cardiovascular Disease Events (PREVENT) guidelines include a new risk equation, which would recommend statins for fewer people, according to a team at the University of Pittsburgh, Beth Israel Deaconess Medical Center and University of Michigan.
The report was published Monday in JAMA Internal Medicine. It reviewed the guidelines that update doctors’ calculators for evaluating a patient’s 10-year risk for heart attack or stroke.
If more doctors and patients followed those guidelines, the number of adults on statins would decrease from 45.4 million to 28.3 million. Even though the number would fall, authors of the study said that many people who should be on the drugs are not taking them
As part of the study, the team evaluated data from 3,785 adults, ages 40 to 75, who were part of the National Health and Nutrition Examination Survey from January 2017 to March 2020.
Investigators estimated the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the PREVENT equations and compared the results to risk estimated using the previous tool, which was called the Pooled Cohort Equations (PCE).
Among all the participants, the 10-year risk of developing ASCVD was 4%, which is half of the risk calculated by the PCE (8%). The difference was even larger for Black adults (5.1% versus 10.9%) and for adults between the ages of 70 and 75 (10.2% versus 22.8%).
Current statin use as well as metabolic and kidney diseases are incorporated into the new calculation. At the same time, race has been removed from it.
“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” Timothy Anderson, MD, an author and a primary care physician at UPMC and health services researcher and assistant professor of medicine at Pitt.
About 4.1 million patients who are currently taking statins would no longer be recommended to take them based on PREVENT. For those people and their doctors, clear and careful communication is key, said Anderson.
“We don’t want people to think they were treated incorrectly in the past. They were treated with the best data we had when the PCE was introduced back in 2013. The data have changed,” Anderson said.
A person’s risk can change as time goes on. “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 five years down the road, for the simple reason that everybody’s risk goes up as we get older,” Anderson added.
