Abstract 12490: Class I Indications for Statin Therapy in Primary Prevention by Three Cholesterol Guidelines and Risk of Incident Cardiovascular Outcomes: Multi-ethnic Study of Atherosclerosis (MESA)

Abstract

Introduction: The major societal guidelines on cholesterol treatment (2013 ACC/AHA, 2004 NCEP/ATP III, and the 2011 ESC/EAS) differ in identifying patients with a class 1 recommendation for statin therapy for atherosclerotic cardiovascular disease (ASCVD). ACC/AHA emphasizes a need for clinician-patient dialogue on the risks/benefits of statins in primary prevention of ASCVD. Limited data exist on the accuracy of statin-eligibility (Class I) for ASCVD events to inform this dialogue. We assessed the accuracy of class I statin eligibility with incident ASCVD events by ACC/AHA compared with NCEP/ATP III and ESC/EAS guidelines. Methods: We evaluated the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) of class I recommendation for statin therapy by each guideline for respective 10 yr. adjudicated incident ASCVD outcomes [NCEP/ATP III- MI, CHD death; ACC/AHA- MI, CHD death, fatal/non-fatal strokes; ESC/EAS: ASCVD death] in participants of the Multi Ethnic Study of Atherosclerosis. We stratified analysis by age, sex, and race. 4723 out of 6814 persons, not on statins at baseline, had complete data. Results: Mean age was 59±9 yrs., 47% male, 37% white, 28% African American (AA), 23% Hispanic, and 12% Asian, 7.5% T2DM, 15%/35% current/former smokers, and mean BMI of 28±6 kg/m2. 7.3% had ASCVD, 5.2% ASCVD death and 5.1% had a CHD event after 10 yrs. See Table 1 for results. Subgroup analysis shows AHA/ACC had a higher SN and lower SP in men vs. women (SN = 76% vs. 46%, SP = 54% vs. 77%) and in those >60 vs. <60 yrs (SN = 79% vs. 40%, SP = 41% vs. 85%). For AHA/ACC, SN was highest in Asians (75%) followed by AA (74%), Hispanics (56%), whites (56%). SP in whites (70%), Hispanics (68%), Asians (68%), AA (60%) Conclusions: Class I statin indication by all 3 guidelines have relatively low sensitivities for a good screening tool. ACC/AHA has higher SN, lower SP, similar NPV and higher PPV compared with NCEP/ATP III and ESC/EAS for primary ASCVD events.