Physicians' Academy for Cardiovascular Education

New criteria would shift statin eligibility to more subjects at intermediate CV risk

Statin Eligibility in Primary Prevention: From a Risk-Based Strategy to a Personalized Approach Based on the Predicted Benefit

Literature - Cesena FHY, Laurinavicius AG, Valente VA, et al. - Am J Cardiol 2018; published online ahead of print

Introduction and methods

Current guidelines recommend statin prescription in primary prevention according to the calculated absolute risk of CVD [1]. However, the treatment benefit depends also on the amount of LDL-c lowering, therefore, a benefit-based strategy for statin eligibility has been proposed, according to which, only individuals with an expected absolute risk reduction above a threshold would be candidates for statin therapy [2,3].

In this cross-sectional study, statin eligibility was assessed based on the predicted CV benefit, rather than the absolute CV risk, in a large database of individuals in primary prevention. Eligible for the study were 16,008 subjects aged 40-75 years, with LDL-c between 70 and 190 mg/dL, not on lipid-lowering drugs, who underwent a routine health screening in a single center.

The 10-year CV risk was calculated by the pooled cohort equations, according to the 2013 ACC/AHA guideline recommendation, and statin eligibility was defined as a 10-year CV risk ≥7.5% [4]. The predicted number needed to treat (NNT) to prevent one major CV event over 10 years (NNT10) was calculated as the reciprocal of the expected absolute risk reduction. The NNT10 threshold that resulted in the same number of statin candidates as in the risk-based approach, was called equivalent NNT10.

Main results

Conclusion

Defining statin eligibility based on the predicted CV benefit, rather than the absolute CV risk, shifts statin eligibility to more intermediate CV risk subjects, without changing the overall rate of statin use in the population.

References

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Find this article online at Am J Cardiol 2018