Study Finds Not All Statin Guidelines Equal for ASCVD Prevention

October 2, 2019
Patrick Campbell

A study from investigators in Europe found the CCS, ACC/AHA, and NICE guidelines for statin use may be more effective at preventing ASCVD events than ESC/EAS or USPSTF guidelines.

Not all guidelines are created equal—at least that is what the results of a recent study would seem to suggest.

Analysis of statin use for the primary prevention of atherosclerotic cardiovascular disease(ASCVD) revealed results suggesting guidelines from the Canadian Cardiovascular Society(CCS), American College of Cardiology/American Heart Association (ACC/AHA), and the National Institute for Health and Care Excellence(NICE) may be preferred for prevention over the US Preventive Services Task Force(USPSTF) and European Society of Cardiology/European Atherosclerosis Society(ESC/EAS) guidelines.

In an effort to evaluate the sensitivity, specificity, and estimated number need to treat (NNT10) to prevent 1 ASCVD in 10 years according to criteria from the 5 guidelines, investigators designed a population-based contemporary cohort study using patient data from the Copenhagen General Population Study. The study population had a mean follow-up time of 10.9 years and investigators analyzed data from 45,750 individuals aged between 40 and 75 years from the cohort for the current study.

Investigators chose major guidelines published after 2014 and the 5 guidelines included came from the CCS in 2016, NICE in 2014, USPSTF in 2016, ACC/AHA in 2018, and ESC/EAS in 2016. For the current analysis, ASCVD events were defined as nonfatal myocardial infarction(MI), fatal coronary heart disease(CHD), and stroke.

Of the 45,750 individuals included in the study, the mean age was 56 years and 19,870 (43%) were men. Additionally, the population had a mean systolic blood pressure of 139 mmHg, mean diastolic blood pressure of 84 mmHG, and mean total cholesterol of 220 mg/dL. Investigators noted a total of 4156 ASCVD events were observed during the follow-up period.

Upon analyses, investigators found 44% (19,953) of individuals were statin eligible with CCS guidelines, 42% (19,400) with ACC/AHA guidelines, 40% (19,400) with NICE, 31% with USPSTF), and 15% (6870) with ESC/EAS. In regard to sensitivity and specificity, percentages for each were 68% (n = 2815 of 4156) and 59% (n = 24 456 of 41 594) for CCS, 70% (2889 of 4156) and 60% (25,083 of 41,594) for ACC/AHA, 68% (n = 2815 of 4156) and 63% (26,213 of 41,594) for NICE, 57% (2377 of 4156) and 72% (30,005 of 41,594) for USPSTF, and 24% (1001 of 4156) and 86% (35,725 of 41,594) for ESC/EAS.

Additionally, investigators noted the NNT10 to prevent a single ASCVD event using moderate-intensity and high-intensity statin therapy, respectively, was 32 and 21 for CCS guidelines, 30 and 20 for ACC/AHA guidelines, 30 and 20 for NICE guidelines, 27 and 18 for USPSTF guidelines, and 29 and 20 for ESC/EAS guidelines.

Investigators suggest the results of their study indicate the CCS, ACC/AHA, or NICE guidelines may be preferred over USPSTF and ESC/EAS guidelines for primary prevention of ASCVD.

“These results are important for clinical practice because they demonstrate that the greater potential for reducing ASCVD burden in the population with the more statin-liberal guidelines is not counteracted by higher number need to treat to prevent ASCVD events, as compared with the more statin-conservative guidelines,” investigators wrote.

This study, “Statin Use in Primary Prevention of Atherosclerotic Cardiovascular Disease According to 5 Major Guidelines for Sensitivity, Specificity, and Number Needed to Treat,” was published in JAMA Cardiology.