Atherosclerotic cardiovascular disease is a condition characterized by plaque buildup in blood vessels, which can increase the risk of serious cardiovascular events like heart attacks and strokes. One type of medication that can help prevent such events is statins. Doctors assess various factors to determine if statin therapy is appropriate for an individual. The American Heart Association recently updated its risk equations for predicting cardiovascular disease events, which has implications for clinical practice and medication recommendations.
A recent study published in JAMA Internal Medicine found that using the latest risk equations, known as the PREVENT equations, could lead to fewer adults meeting eligibility criteria for primary prevention statin therapy. This could result in significant changes in the number of people prescribed statins. Doctors face challenges in prescribing medications, weighing potential risks and benefits based on official recommendations from governing bodies and medical organizations. Researchers aim to understand how guideline changes impact clinical practice and medication recommendations.
Atherosclerotic cardiovascular disease can be caused by the buildup of plaque in the arteries, restricting blood flow to vital organs. This condition can lead to serious health consequences, including heart attacks and strokes. Statins are commonly prescribed to individuals at risk for atherosclerotic cardiovascular disease, as well as those with high cholesterol levels. The decision to start statin therapy depends on a thorough evaluation of an individual’s cardiovascular disease risk factors. Risk calculators are often used to estimate an individual’s 10-year risk for developing cardiovascular disease.
The study compared two sets of risk equations, the PCEs and the PREVENT equations, to measure 10-year atherosclerotic cardiovascular disease risk and their impact on primary prevention statin therapy recommendations. Using the PREVENT equations significantly reduced the average estimated risk for cardiovascular disease and could lead to a decrease in the number of adults eligible for statin therapy. The study included a weighted sample of 3,785 adults and analyzed data from the NHANES to determine changes in statin recommendations based on the two equation sets.
Some limitations of the study include reliance on self-reported data from NHANES, potential errors in survey responses, and the lack of information on statin dosage, medication adherence, and HDL cholesterol levels. Additionally, the study did not consider other risk enhancers for cardiovascular disease or alternative lipid-lowering therapies. More research is needed to determine the most accurate risk assessment equations for clinical practice and how to improve risk communication with patients. Moving forward, doctors may consider adjusting treatment thresholds and utilizing additional tests to make informed treatment recommendations.
The findings of this study have potential implications for clinical practice, including a possible decrease in patients receiving statin therapy and an increased risk of cardiovascular events. Utilizing additional testing, such as coronary artery calcium scoring or lipoprotein a testing, may help determine if patients would benefit from statin therapy. Future guidelines may need to adjust risk thresholds for starting statin therapy based on the latest risk equations. Overall, ongoing research is necessary to inform optimal treatment recommendations for individuals at risk for atherosclerotic cardiovascular disease.
