Broader statin use more likely to prevent cardiovascular events

1. High levels of agreement between statin eligibility found between several guidelines included in this study.

2. Statin eligibility, among patients, increased significantly with increased age.

Evidence Rating Level: 2 (Good)

Study Rundown: Statins remain an important therapy to help reduce the number of atherosclerotic cardiovascular disease (ASCVD) events. Statins have been shown to be both effective and safe in terms of primary and secondary prevention of ASCVD. There are 5 organizations that have published major guidelines on the use of statins for primary ASCVD prevention. These guidelines include: the American College of Cardiology/American Heart Association (ACC/AHA), the United Kingdom’s National Institute for Health and Care Excellence (NICE), the Canadian Cardiovascular Society (CCS), the U.S> Preventive Services Task Force (USPSTF), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). The authors of this study aimed to compare the utility of the above guidelines with respect to primary prevention of ASCVD. In general, it was observed that broader statin use is more likely to prevent cardiovascular events. Similar levels of agreement between guidelines were observed for statin eligibility and protection against ASCVD events. This study has several limitations. First, the study’s demographics were restricted to Caucasian Europeans. As a result, translation of the results of the study to other patient populations may not be accurate and additional studies may be required to apply the results to other demographic groups. Second, the authors did not account for patients that acquired prescription for preventative medicine during follow-up appointments.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Interpretation of the evidence for the efficacy and safety of statin therapy

In-Depth [prospective cohort]: The authors of this study utilized the Copenhagen General Population Study to conduct a modeling study that assessed the effectiveness of the five major guidelines regarding statin use and recommendations. Sensitivity analyses were also performed. In total 45 750 Danish patients aged 40 to 75 were included in the study. At baseline, these patients had not previously used statins and had no ASCVD events. Generally, the authors observed a relative agreement of 59%-76% in statin eligibility between the CCS, ACC/AHA, NICE, and USP-STF guidelines. Lower agreement was observed between ESC/EAS and other guidelines. Furthermore, it was observed that when high-intensity statins were used, similar levels for potential reduction of all ASCVD events over 10 years were found between guidelines. Specifically, the potential reduction included 34% for CCS, 34% for ACC/AHA, 32% for NICE, 27% for USPSTF, and 13% for ESC/EAS.

Image: PD

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