Thanassoulis G, et al. - Researchers evaluated the impact of a 30-year benefit approach to select individuals for statin therapy. Nearly 1 in 6 individuals are identified by a long-term benefit approach to statin eligibility as having a high degree of expected long-term benefit from statins, with a number needed to treat of less than 7. Younger individuals with higher low-density lipoprotein cholesterol (LDL-C) levels who would not be currently recommended for treatment are identified by this approach. Furthermore, this affords a more optimal approach for determining statin eligibility in primary prevention.

Methods

• Experts conducted a cross-sectional analysis of the National Health and Nutrition Survey (NHANES) data set that included samples of the US population from the 2009-2010, 2011-2012, and 2013-2014 data collection cycles.
• They included the individuals between 40 to 60 years old who did not have atherosclerotic cardiovascular disease, diabetes, or LDL-C levels greater than 190 mg/dL and who were not taking statins.
• They analyzed the data from November 2017 to August 2018.
• For each individual, 10-year risk of atherosclerotic cardiovascular disease and 10-year and 30-year absolute risk reduction (10-year ARR and 30-year ARR) of atherosclerotic cardiovascular disease were calculated.
• Main outcomes and measures included the number of individuals meeting eligibility for statins based on 10-year (atherosclerotic) cardiovascular disease risk, 10-year ARR, or 30-year ARR.

Results

• Authors included a total of 1,688 individuals, representing 56.6 million US individuals.
• Findings suggested the statin eligibility based on 7.5% CVR10 to be 9.5%, based on 2.3% 10-year ARR, 13.0%, and based on 15% 30-year ARR, 17.5%.
• At 30 years, similar acceptable mean absolute risk reductions were led by the 10-year risk, 10-year benefit, and 30-year benefit approaches with the benefit-based approaches better able to avoid treatment of individuals with low expected benefit.
• Compared to those recommended with a 10-year ARR threshold of 2.3% or greater (mean age, 56 [95% CI, 54-57] years; 22% [95% CI, 10%-34%] women), individuals who met statin eligibility based solely on the 30-year ARR threshold of 15% or greater were younger (mean age, 50 [95% CI, 48-52] years) and more likely to be women (43% [95% CI, 26%-59%]) .
• Moreover, lower 10-year risk (mean risk, 4.7% [95% CI, 4.4%-5.1%]) and higher LDL-C levels (mean level, 149 mg/dL [95% CI, 142-155 mg/dL]) were also seen in this group than those recommended with a 10-year ARR threshold of 2.3% or greater (mean risk, 9.3% [95% CI, 8.3%-10.2%]; mean LDL-C levels, 110 [103-118] mg/dL).
• Using the 30-year benefit approach (296,000 at 10 years and 2.03 million at 30 years), preventable atherosclerotic cardiovascular disease events in 10 and 30 years were highest, and these were lowest based on 10-year risk (204,000 at 10 years and 1.18 million at 30 years).