Abstract 18914: Comparison of Statin Eligibility Using the Pooled Cohort Equations, ATP-III Framingham and Reynolds Risk Scores Among Adults Who Experienced ASCVD Events: The Atherosclerosis Risk in Communities Study

Abstract

Background: The 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol recommended initiating statin therapy when an individual’s 10-year estimated ASCVD risk ≥7.5% We sought to determine whether adults who eventually experienced ASCVD events were more likely to be identified as having ≥7.5% risk using the ACC/AHA’s Pooled Cohort Equations (PCE) compared to the ATP III-Framingham (FRS) and Reynolds risk scores (RRS). Methods: We used data from the biracial Atherosclerosis Risk in Communities Study (ARIC) visit 4 (1996-1998) because hsCRP was measured at this exam. We excluded participants with an ASCVD event prior to visit 4, diabetes, statin use at visit 4, age>74, LDL-C >190 mg/dl, or missing data. Published models for the PCE, ATP III-FRS, and RRS estimated risk. We defined statin eligibility as an estimated 10-year risk ≥7.5% for the PCE and RRS, and ≥10% for the ATP III-FRS. The primary outcome for each score was based on the outcomes originally used to derive the scores: ATP III-FRS (MI or CHD death), PCE (MI, CHD death, stroke) and RRS (MI, CHD death, stroke and revascularization). Results: Using the PCE, 2592 participants had an estimated risk ≥7.5% and 2760 <7.5%. The median age among those with estimated risk ≥7.5% was 66; 19% were black and 35% were women. Over a median of 11 years 304 CHD events, 201 strokes and 432 revascularizations occurred. With all 3 risk scores >80% of men who experienced events had an estimated risk ≥7.5% (see Table). In contrast, a much smaller proportion of women who experienced events had an estimated risk ≥7.5%, although the PCE yielded the highest proportion (52%). Conclusions: A cutoff of ≥7.5% 10-year ASCVD risk identified the majority of male participants in ARIC who experienced subsequent ASCVD events regardless of the risk score used. Substantially fewer women who experienced events were identified. Lower risk cutoffs or additional markers of ASCVD risk may be required when making decisions about statin therapy for women.