New Cholesterol Guidelines Would Significantly Increase Statin Use If Implemented

• Published in: Journal of clinical outcomes management Vol. 21; no. 5; p. 1
• Main Authors: Pencina, MJ, Navar-Boggan, AM, D'Agostino, RB
• Format: Journal Article
• Language: English
• Published: Wayne Turner White Communications Inc 01.05.2014
• Subjects: Cardiovascular disease; Cholesterol; Medical treatment; Risk factors; Statins; United States > US
• ISSN: 1079-6533; 1938-1336

To quantify how many people would qualify for statin treatment under the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines [1]. Descriptive, repeated cross-sectional study examining data from the 2005-2010 National Health and Nutrition Examination Surveys (NHANES). Data on the medical diagnoses and risk factors for cardiovascular disease for NHANES participants aged 40-75 years (n = 3773) were used to extrapolate to 115.4 million US adults in the same age-range. Exclusions were for triglyceride levels > 400 mg/dL (100 participants) and missing LDL cholesterol measurement (36 participants). Percentage of the US adult population that would be recommended statin therapy according to the 2013 ACC/AHA guidelines as compared with the 2004 guideline produced by the Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program [2,3]. Of the NHANES participants, 49% were male, 13% had cardiovascular disease, 46% had hypertension, 21% had diabetes, 21% were smokers, and 41% had obesity. Median age was 56 years (interquartile range [IQR], 41-73), median total cholesterol was 199 mg/dL (IQR, 138-272), median LDL cholesterol was 118 mg/dL (IQR, 64-182), and HDL cholesterol was 52 mg/dL (IQR, 33-86). Overall, 2135 participants (57%) qualified for statin treatment according to the ACC/AHA guidelines as compared with 1583 (42%) under the ATP III guidelines. Additional participants qualifying under the ACC/AHA guideline were more likely to be male, older in age, have a lower LDL cholesterol, and without known cardiovascular disease, diabetes, obesity, or hypertension. Extrapolated to the US population, 56 million people (49% of the US population age 40 to 75 years, 95% CI, 46-51) would be recommended for statin treatment under the ACC/AHA guidelines compared with 43.2 million (37.5%, 95% CI, 35.3-39.7) under ATP III. Most new candidates for statins meet criteria for primary prevention of a cardiovascular event: 2.2 million persons with diabetes and 8.2 million considered at high risk for an event in 10 years based on the new ACC/AHA risk calculator [4]. Age also was an important predictor of newly eligible statin candidates. According to ATP III, 48% of 60- to 75-year-olds would qualify for treatment, but 78% would qualify based on ACC/AHA. According to extrapolated NHANES data, 25.2 million people were taking statins from 2005 to 2010; the ACC/AHA guidelines would more than double this number. The 2013 ACC/AHA cholesterol treatment guidelines would substantially increase the number of patients recommended for statin therapy.