Abstract 123: Yield of Lipid Screening for Primary Prevention in a Young Cohort of Non-diabetic Patients Using the 2013 ACC/AHA ASCVD Risk Calculator

Abstract

Background/Aim: The 2013 ACC/AHA cholesterol management guidelines advise checking lipids in all adults aged > 20 years and repeating it every 4-6 years to identify individuals at high risk for atherosclerotic cardiovascular disease (ASCVD) because they may benefit from treatment. Statins can be considered in young adults with elevated ten year risk (defined as >5%) or LDL cholesterol >190 mg/dl. We aimed to assess the yield of lipid screening in this population. Methods: We conducted a retrospective cross-sectional study of patients aged 30-49 years who had lipid screening at their first primary care visit at a large health system from 2003-2012. Patients with known ASCVD and diabetes were excluded. We calculated 10-yr ASCVD risk by extrapolating the 2013 ACC/AHA ASCVD risk calculator to this population. Patients were subdivided by age in 5 year intervals, gender and history of smoking and hypertension. We calculated the percentage of patients with risk >5% and patients or LDL >190 mg/dl in each subgroup. Results: A total of 47,495 patients were included. The total number in each subgroup and the percentage with 10-yr estimated ASCVD risk >5% are shown in Table 1. Approximately half (49.2%, 23,388/47,495) the population had very low risk with only 18/ 23,388 (0.08%) non-smoking, non-hypertensive patients having an elevated risk. Only 1/15,618 (0.006%) non-smoking non-hypertensive females <50 years had a high risk. Less than 0.5% of non-smoking non-hypertensive males <45 years had a risk >5%. From 1% to >75% of population in other subgroups had an elevated risk depending on risk factors. Only 667/ 47,495 (1.4%) patients had LDL cholesterol >190 mg/dl. Conclusion: Yield of lipid screening is very low in non-smokers, especially in normotensive females <50 years and males <45 years, which constitute one-half of the screened population. Also, only 1.4% of the entire population cohort <50 years had elevated LDL>190 mg/dl. Guidelines for lipid screening should be reassessed for healthy non-smoking normotensive adults under 50 years of age.