Primary Prevention With Statins: ACC/AHA Risk-Based Approach Versus Trial-Based Approaches to Guide Statin Therapy

Martin B Mortensen; Shoaib Afzal; Børge G Nordestgaard; Erling Falk

doi:10.1016/j.jacc.2015.09.089

Primary Prevention With Statins: ACC/AHA Risk-Based Approach Versus Trial-Based Approaches to Guide Statin Therapy

Martin B Mortensen, Shoaib Afzal, Børge G Nordestgaard, Erling Falk

Institut for Klinisk Medicin

44 Citationer (Scopus)

Abstract

BACKGROUND: Guidelines recommend initiating primary prevention for atherosclerotic cardiovascular disease (ASCVD) with statins based on absolute ASCVD risk assessment. Recently, alternative trial-based and hybrid approaches were suggested for statin treatment eligibility.

OBJECTIVES: This study compared these approaches in a direct head-to-head fashion in a contemporary population.

METHODS: The study used the CGPS (Copenhagen General Population Study) with 37,892 subjects aged 40 to 75 years recruited in 2003 to 2008, all free of ASCVD, diabetes, and statin use at baseline.

RESULTS: Among the population studied, 42% were eligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) risk assessment and cholesterol treatment guidelines approach, versus 56% with the trial-based approach and 21% with the hybrid approach. Among these statin-eligible subjects, the ASCVD event rate per 1,000 person-years was 9.8, 6.8, and 11.2, respectively. The ACC/AHA-recommended absolute risk score was well calibrated around the 7.5% 10-year ASCVD risk treatment threshold and discriminated better than the trial-based or hybrid approaches. Compared with the ACC/AHA risk-based approach, the net reclassification index for eligibility for statin therapy among 40- to 75-year-old subjects from the CGPS was -0.21 for the trial-based approach and -0.13 for the hybrid approach.

CONCLUSIONS: The clinical performance of the ACC/AHA risk-based approach for primary prevention of ASCVD with statins was superior to the trial-based and hybrid approaches. Our results indicate that the ACC/AHA guidelines will prevent more ASCVD events than the trial-based and hybrid approaches, while treating fewer people compared with the trial-based approach.

Originalsprog	Engelsk
Tidsskrift	Journal of the American College of Cardiology
Vol/bind	66
Udgave nummer	24
Sider (fra-til)	2699-709
Antal sider	11
ISSN	0735-1097
DOI	https://doi.org/10.1016/j.jacc.2015.09.089
Status	Udgivet - 22 dec. 2015

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10.1016/j.jacc.2015.09.089

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title = "Primary Prevention With Statins: ACC/AHA Risk-Based Approach Versus Trial-Based Approaches to Guide Statin Therapy",

abstract = "BACKGROUND: Guidelines recommend initiating primary prevention for atherosclerotic cardiovascular disease (ASCVD) with statins based on absolute ASCVD risk assessment. Recently, alternative trial-based and hybrid approaches were suggested for statin treatment eligibility.OBJECTIVES: This study compared these approaches in a direct head-to-head fashion in a contemporary population.METHODS: The study used the CGPS (Copenhagen General Population Study) with 37,892 subjects aged 40 to 75 years recruited in 2003 to 2008, all free of ASCVD, diabetes, and statin use at baseline.RESULTS: Among the population studied, 42% were eligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) risk assessment and cholesterol treatment guidelines approach, versus 56% with the trial-based approach and 21% with the hybrid approach. Among these statin-eligible subjects, the ASCVD event rate per 1,000 person-years was 9.8, 6.8, and 11.2, respectively. The ACC/AHA-recommended absolute risk score was well calibrated around the 7.5% 10-year ASCVD risk treatment threshold and discriminated better than the trial-based or hybrid approaches. Compared with the ACC/AHA risk-based approach, the net reclassification index for eligibility for statin therapy among 40- to 75-year-old subjects from the CGPS was -0.21 for the trial-based approach and -0.13 for the hybrid approach.CONCLUSIONS: The clinical performance of the ACC/AHA risk-based approach for primary prevention of ASCVD with statins was superior to the trial-based and hybrid approaches. Our results indicate that the ACC/AHA guidelines will prevent more ASCVD events than the trial-based and hybrid approaches, while treating fewer people compared with the trial-based approach.",

keywords = "Adult, Aged, Aged, 80 and over, Atherosclerosis, Denmark, Female, Follow-Up Studies, Guideline Adherence, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Morbidity, Primary Prevention, Prospective Studies, Risk Assessment, Risk Factors, Treatment Outcome, Young Adult",

author = "Mortensen, {Martin B} and Shoaib Afzal and Nordestgaard, {B{\o}rge G} and Erling Falk",

year = "2015",

month = dec,

day = "22",

doi = "10.1016/j.jacc.2015.09.089",

language = "English",

volume = "66",

pages = "2699--709",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

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number = "24",

}

TY - JOUR

T1 - Primary Prevention With Statins

T2 - ACC/AHA Risk-Based Approach Versus Trial-Based Approaches to Guide Statin Therapy

AU - Mortensen, Martin B

AU - Afzal, Shoaib

AU - Nordestgaard, Børge G

AU - Falk, Erling

PY - 2015/12/22

Y1 - 2015/12/22

N2 - BACKGROUND: Guidelines recommend initiating primary prevention for atherosclerotic cardiovascular disease (ASCVD) with statins based on absolute ASCVD risk assessment. Recently, alternative trial-based and hybrid approaches were suggested for statin treatment eligibility.OBJECTIVES: This study compared these approaches in a direct head-to-head fashion in a contemporary population.METHODS: The study used the CGPS (Copenhagen General Population Study) with 37,892 subjects aged 40 to 75 years recruited in 2003 to 2008, all free of ASCVD, diabetes, and statin use at baseline.RESULTS: Among the population studied, 42% were eligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) risk assessment and cholesterol treatment guidelines approach, versus 56% with the trial-based approach and 21% with the hybrid approach. Among these statin-eligible subjects, the ASCVD event rate per 1,000 person-years was 9.8, 6.8, and 11.2, respectively. The ACC/AHA-recommended absolute risk score was well calibrated around the 7.5% 10-year ASCVD risk treatment threshold and discriminated better than the trial-based or hybrid approaches. Compared with the ACC/AHA risk-based approach, the net reclassification index for eligibility for statin therapy among 40- to 75-year-old subjects from the CGPS was -0.21 for the trial-based approach and -0.13 for the hybrid approach.CONCLUSIONS: The clinical performance of the ACC/AHA risk-based approach for primary prevention of ASCVD with statins was superior to the trial-based and hybrid approaches. Our results indicate that the ACC/AHA guidelines will prevent more ASCVD events than the trial-based and hybrid approaches, while treating fewer people compared with the trial-based approach.

AB - BACKGROUND: Guidelines recommend initiating primary prevention for atherosclerotic cardiovascular disease (ASCVD) with statins based on absolute ASCVD risk assessment. Recently, alternative trial-based and hybrid approaches were suggested for statin treatment eligibility.OBJECTIVES: This study compared these approaches in a direct head-to-head fashion in a contemporary population.METHODS: The study used the CGPS (Copenhagen General Population Study) with 37,892 subjects aged 40 to 75 years recruited in 2003 to 2008, all free of ASCVD, diabetes, and statin use at baseline.RESULTS: Among the population studied, 42% were eligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) risk assessment and cholesterol treatment guidelines approach, versus 56% with the trial-based approach and 21% with the hybrid approach. Among these statin-eligible subjects, the ASCVD event rate per 1,000 person-years was 9.8, 6.8, and 11.2, respectively. The ACC/AHA-recommended absolute risk score was well calibrated around the 7.5% 10-year ASCVD risk treatment threshold and discriminated better than the trial-based or hybrid approaches. Compared with the ACC/AHA risk-based approach, the net reclassification index for eligibility for statin therapy among 40- to 75-year-old subjects from the CGPS was -0.21 for the trial-based approach and -0.13 for the hybrid approach.CONCLUSIONS: The clinical performance of the ACC/AHA risk-based approach for primary prevention of ASCVD with statins was superior to the trial-based and hybrid approaches. Our results indicate that the ACC/AHA guidelines will prevent more ASCVD events than the trial-based and hybrid approaches, while treating fewer people compared with the trial-based approach.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Atherosclerosis

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - Guideline Adherence

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors

KW - Male

KW - Middle Aged

KW - Morbidity

KW - Primary Prevention

KW - Prospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1016/j.jacc.2015.09.089

DO - 10.1016/j.jacc.2015.09.089

M3 - Journal article

C2 - 26700832

SN - 0735-1097

VL - 66

SP - 2699

EP - 2709

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 24

ER -

Primary Prevention With Statins: ACC/AHA Risk-Based Approach Versus Trial-Based Approaches to Guide Statin Therapy

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