Statins with borderline ASCVD risk offer benefit, regardless of LDL-C

  • Kohli-Lynch CN & al.
  • JAMA Cardiol
  • 28 Aug 2019

  • International Clinical Digest
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Takeaway

  • Statins for patients with borderline 10-year atherosclerotic cardiovascular disease (ASCVD) risk offer health and economic benefits in the long term.

Why this matters

  • Current US guidelines foreground using high ASCVD 10-year risk in choosing statins for primary prevention; borderline risk is 5.0%-7.4%.

Key results

  • Each of 100 simulated cohorts had 1 million patients (1:1 female:male), age 40 years.
  • With statins for all patients with borderline ASCVD risk regardless of low-density lipoprotein cholesterol (LDL-C): 
    • Most ASCVD events would be prevented, with 
    • $33,558 saved per quality-adjusted life-year (QALY) gained.
  • QALYs increased with statin treatment at higher LDL-C levels.
  • Projected numbers taking statins would increase by:
    • 2 million US adults with borderline ASCVD risk, LDL-C 160-180 mg/dL; 
    • 6 million with inclusion of all with at least borderline ASCVD risk and LDL-C 130-159 mg/dL; and
    • 11 million with inclusion of everyone with borderline ASCVD risk.

Study design

  • Cohorts developed from 1999-2014 US National Health and Nutrition Examination Surveys data.
  • 4 statin treatment strategies simulated:
    • Standard of care (ASCVD 10-year risk, 7.5%; diabetes; or LDL-C ≥190 mg/dL).
    • Borderline risk (≥5%) with:
      • LDL-C, 160-189 mg/dL or
      • LDL-C, 130-159 mg/dL; or
    • All with borderline risk.
  • Funding: Medical Research Council, UK; National Heart, Lung, and Blood Institute.

Limitations

  • Statin benefit based only on LDL-C effects and not other outcomes.

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