A new study suggests that if national guidelines are updated to include a new risk equation, approximately 40% fewer individuals may qualify for cholesterol-lowering statins in order to prevent heart disease. The study explores the potential impact of widespread adoption of the PREVENT equations, which were introduced by the American Heart Association in November 2023 to update the calculators used by physicians to assess patients’ 10-year risk of heart attack or stroke.According to a study conducted by researchers at the University of Pittsburgh, Beth Israel Deaconess Medical Center, and the University of Michigan, published in JAMA Internal Medicine, the study looks at the potential impact of widespread use of the PREVENT equations. These equations were released by the American Heart Association in November 2023 to update the calculators used by physicians to assess the 10-year risk of heart attack or stroke in patients.
The study found that at a population level, the number of adults recommended for statins could decrease from 45.4 million to 28.3 million. Additionally, the study indicated that most people would see a decline in their estimated risk of heart attack or stroke.People who should be taking statins are currently not doing so. According to Dr. Timothy Anderson, M.D., M.A.S., a primary care physician at UPMC and assistant professor of medicine at Pitt, there is an opportunity to focus on and invest resources in high-risk patient populations. The team’s analysis used data from 3,785 adults aged 40 to 75 who participated in the National Health and Nutrition Examination Survey from January 2017 to March 2020 to estimate the 10-year risk of atherosclerotic cardiovascular disease.the risk assessment to avoid perpetuating racial disparities in cardiovascular care. the study found that the PREVENT equations provided a more accurate estimation of ASCVD risk compared to the previous PCE tool. This suggests that the updated equations may be more effective in guiding clinical decisions and preventive interventions for cardiovascular disease. The researchers noted that the use of outdated and less diverse data in the PCE equations may have led to an underestimation of risk for certain patient populations. The findings highlight the importance of regularly updating and refining risk assessment tools to ensure they accurately reflect the current population and incorporate the latest scientific knowledge. Additionally, the removal of race from the risk calculation underscores the need to address and mitigate racial disparities in cardiovascular health.It reflects an increasing awareness that race is a social construct.
The team utilized PREVENT and discovered that the overall 10-year risk of developing ASCVD in the study’s cohort was 4%, which is half as high as the risk calculated by the PCE (8%). The difference was even more significant for Black adults (5.1% versus 10.9%) and for adults aged 70-75 (10.2% versus 22.8%).
An estimated 4.1 million patients currently taking statins would no longer be recommended to do so based on PREVENT. Anderson emphasized the importance of clear and careful communication for these patients and their physicians. “We don’t want people to think they were treated”ted incorrectly in the past. They were treated with the best data we had when the PCE was introduced back in 2013. The data have changed.”
Meanwhile, it’s important to acknowledge that everyone’s risk will naturally evolve over time, as well, he noted. “For a patient whose risk is now known to be lower than previously thought, if we advise them to discontinue statins, they could still be at a higher risk five years later, simply because everyone’s risk increases as we age.”
Additional authors of the study included Linnea Wilson, M.P.H., of Beth Israel Deaconess Medical Center, and Jeremy B. Sussman, M.D., MUniversity of Michigan, Ann Arbor, conducted the research. The National Institute on Aging (#K76AG074878) provided support for the research.
