Study shows that small differences in cholesterol guidelines can have a big impact on statin use at a population level.
Study also showed that the individual’s plaque score could potentially help with the decision to start statin therapy if recommendations from the two guidelines were inconsistent.
Minneapolis, MN / Anaheim, CA – November 12, 2017 – Michael Miedema, MD MPH of Minneapolis Heart Institute Foundation presented an analysis on the differences in statin eligibility between the two most recent cholesterol guidelines today at the 2017 AHA Scientific Sessions. Compared to ACC/AHA guidelines, application of the USPSTF statin guidelines resulted in a 15% absolute decrease in statin eligibility. Subsequent analysis of individuals with discordant recommendations (those eligible by ACC/AHA but not USPSTF) showed that an individual’s coronary artery calcium (CAC) score can help determine if the patient should take a statin.
Dr. Michael Miedema of the Minneapolis Heart Institute Foundation commented on the study, “We found that roughly half of middle-aged adults in our study qualified for statin therapy by the ACC/AHA guidelines while just over a 1/3 qualified by USPSTF.” Miedema added, “Therefore, 1 in 6 adults in our study would be recommended to take a statin by one guideline but not by the other.”
Additionally, the study evaluated CAC scores as well as subsequent rates of heart attack and stroke according to eligibility categories in the guidelines. “The USPSTF guidelines are more conservative and have a higher risk threshold for treatment, it therefore isn’t surprising that we found that, compared to those eligible by ACC/AHA, those eligible by USPSTF were more likely to have heart attacks and strokes over time.” stated Miedema. “However, the more important finding is that for those 1 in 6 with unclear recommendations, if their calcium score was elevated, they were at high risk for heart attacks during follow-up while those with zero CAC were much less likely to have a cardiovascular event, suggesting the CAC score can be used as the tie-breaker in people with unclear recommendations.”
The study found that statin eligibility according to the 2016 USPSTF guidelines was significantly lower compared to the 2013 ACC/AHA guidelines, with 34% of MESA participants eligible according to USPSTF guidelines compared with 49% eligible for a risk-based statin discussion according to the ACC/AHA guidelines. Of the 15% with discordant eligibility recommendations, 52% had zero CAC and they subsequently had a 4.8% risk for a cardiovascular event over the next 10 years while 20% had CAC score > 100 and they had a 13.8% risk for cardiovascular event over the next decade.
About the Minneapolis Heart Institute Foundation®
The Minneapolis Heart Institute Foundation (MHIF) strives to create a world without heart and vascular disease. To achieve this bold vision, it is dedicated to improving the cardiovascular health of individuals and communities through innovative research and education.
- Scientific Innovation and Research — MHIF is a recognized research leader in the broadest range of cardiovascular medicine and population health initiatives. Each year MHIF leads more than 175 active research projects and publishes more than 175 peer-reviewed abstracts. Cardiologists, hospitals and communities around the world adopt MHIF protocols to save lives, improve care and create healthier living opportunities.
- Education and Outreach — MHIF provides more than 10,000 hours of education each year putting its research into practice to improve outcomes. And, MHIF leads cutting-edge, transformative population health research to connect, engage, inform and empower individuals and communities to improve their health.
The Minneapolis Heart Institute Foundation’s work is funded by generous donors and sponsors and supports research initiatives of Minneapolis Heart Institute® at Abbott Northwestern Hospital. Minneapolis Heart Institute® physicians provide care for patients at Abbott Northwestern Hospital in Minneapolis and at 38 community sites across Minnesota and western Wisconsin.