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Medical News Today (MNT)17 Million US Adults May No Longer Receive Statin Therapy for Heart Disease

Updated Risk Equations for Statin Eligibility: Implications for Clinical Practice and Cardiovascular Health

A recent study published in JAMA Internal Medicine examines how updated risk equations, specifically the PREVENT equations, could significantly alter the number of adults eligible for primary prevention statin therapy. This research suggests a potential reduction in statin prescriptions and raises important considerations for clinical practice in cardiovascular risk management.

Key Points:

  • Statins and Cardiovascular Disease: Statins are prescribed to reduce the risk of atherosclerotic cardiovascular disease (ASCVD), which involves plaque buildup in blood vessels, leading to heart attacks and strokes.
  • Updated Risk Equations: The American Heart Association recently updated its risk equations for predicting cardiovascular events, aiming to improve accuracy.
  • Study Focus: The study compared two sets of risk equations – the original Pooled Cohort Equations (PCEs) from 2013 and the new PREVENT equations developed in 2023.
  • Sample and Methodology: Researchers analyzed data from 3,785 adults, representative of the US population, using the National Health and Nutrition Examination Survey (NHANES).
  • Impact on Risk Estimates: The PREVENT equations reduced the average estimated 10-year ASCVD risk from 8% (using PCEs) to 4.3%.
  • Reduction in Statin Eligibility: The number of adults meeting the criteria for primary prevention statin therapy could decrease from 45.4 million to 28.3 million with the use of PREVENT equations.
  • Demographic Differences: The most significant reductions in risk estimates were observed in Black adults (from 10.9% to 5.1%) and adults aged 70-75 (from 22.8% to 10.2%).
  • Factors Considered in PREVENT: The PREVENT equations incorporate additional factors such as kidney function, social deprivation index, and statin use, excluding race.
  • Clinical Implications: If PREVENT equations are adopted, fewer patients may be prescribed statins, potentially leading to changes in cardiovascular and cerebrovascular event rates.
  • Additional Tests for Recommendations: Physicians might need to employ additional tests like coronary artery calcium scoring or lipoprotein a testing to better assess the necessity of statin therapy.

“Depending on how future guidelines are written, this could result in fewer patients being recommended statin therapy. As statins are known to be very helpful in preventing cardiovascular disease, any future guidelines may need to adjust the risk thresholds we use for starting statin therapy.”
– Cheng-Han Chen, MD, Interventional Cardiologist and Medical Director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA

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