Points
- The main aim of this article is to summarize the findings of Gupta et al.’s study, in which they used the data obtained from the National Health and Nutrition Examination Survey (NHANES) to predict the absolute proportion of US adults eligible for statin therapy according to the United States Preventative Services Taskforce (USPSTF) guidelines of 2022 in comparison to 2018 guidelines of American College of Cardiology/American Heart Association/Multisociety (ACC/AHA/MS).
- The other objective was to compare the significant differences between the recommendations of (ACC/AHA/MS) and USPSTF to find discrepancies in the number of adults who fall in the eligibility criteria for a statin.
- Implementing the USPSTF guidelines of 2022, compared to the ACC/AHA/MS guidelines of 2018, reduces the opportunity for ASCVD risk management due to the unavailability of statin therapy for primary prevention of ASCVD and especially for younger adults with diabetes.
Summary
The guidelines of USPSTF provide recommendations for the use of statin therapy for the prevention of atherosclerotic cardiovascular disease (ASCVD) for adults of 40-75 years of age with equal or greater than 1 CVD risk factor (smoking, dyslipidemia, hypertension, diabetes) and measure ASCVD risk of equal or greater than 10% for 10-years.
The guideline of ACC/AHA/MS presented in 2018 recommends the use of statin therapy in adults of 40-75 years of age with low-density lipoprotein-cholesterol (LDL-C) and diabetes mellitus greater than 190 mg/dL irrespective of the risk of ASCVD or those with age range 40-75 with equal or greater than 20% risk of ASCVD for 10 years. They also recommended considering additional risk factors and focused on shared decision-making for starting statin therapy among patients with intermediate and borderline 10-year ASCVD risk. For this purpose, 1799 participants of the age range 40-75 years were selected if ≥1 risk factor for CVD, 10-year ASCVD risk of ≥10%, or diabetes mellitus was present.
According to the recommendation of USPSTF, the criteria for statin use reduce the number of eligible participants compared to the 2018 guidelines of ACC/AHA/ MS. The results of this comparison are consistent with the comparison of guidelines of 2013 AHA/ACC and 2016 USPSTF recommendations. The higher threshold rate of ASCVD risk reduces the number of eligible participants for statin use, according to the recommendation of USPSTF. The criteria for the use of statins for diabetes mellitus also increase the age limit for eligibility for a statin. The proper assessment of risk enhancers also helps in using statin therapy properly. The ACC/AHA/MS guidelines also support using coronary artery calcium scores for deciding statin therapy. As a result, the implementation of the USPSTF guidelines of 2022, compared to the ACC/AHA/MS guidelines of 2018, reduces the opportunity for ASCVD risk management due to the unavailability of statin therapy for primary prevention of ASCVD and especially for younger adults with diabetes.
Link to the article: https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/04/13/38/Comparing-Guideline-Recommendations-of-Statin-Use-For-the-Primary-Prevention-of-ASCVD
References Montovano, M., Stone, N., & Blumenthal, R. (2022, October 4). Comparing guideline recommendations of statin use for the primary prevention of ascvd. American College of Cardiology; American College of Cardiology. https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/04/13/38/Comparing-Guideline-Recommendations-of-Statin-Use-For-the-Primary-Prevention-of-ASCVD
