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