Abstract
BackgroundInitiation of statin therapy as primary prevention particularly in those with mildly elevated cardiovascular disease risk factors is still being debated. The 2013 ACC/AHA blood cholesterol guideline recommends initiation of statin by estimating the 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the new pooled cohort risk score. This paper examines the use of the pooled cohort risk score and compares it to actual use of statins in daily clinical practice in a primary care setting.MethodsWe examined the use of statins in a randomly selected sample of patients in a primary care clinic. The demographic data and cardiovascular risk parameters were captured from patient records in 1998. The pooled cohort risk score was calculated based on the parameters in 1998. The use of statins in 1998 and 2007, a 10-year interval, was recorded.ResultsA total of 847 patients were entered into the analysis. Mean age of the patients was 57.2 ± 8.4 years and 33.1% were male. The use of statins in 1998 was only 10.2% (n = 86) as compared to 67.5% (n = 572) in 2007. For patients with LDL 70-189 mg/dl and estimated 10-year ASCVD risk ≥7.5% (n = 190), 60% (n = 114) of patients were on statin therapy by 2007. There were 124 patients in whom statin therapy was not recommended according to ACC/AHA guideline but were actually receiving statin therapy.ConclusionsAn extra 40% of patients need to be treated with statin if the 2013 ACC/AHA blood cholesterol guideline is used. However the absolute number of patients who needed to be treated based on the ACC/AHA guideline is lower than the number of patients actually receiving it in a daily clinical practice. The pooled cohort risk score does not increase the absolute number of patients who are actually treated with statins. However these findings and the use of the pooled cohort risk score need to be validated further.
Highlights
Initiation of statin therapy as primary prevention in those with mildly elevated cardiovascular disease risk factors is still being debated
Patients without diabetes but with Low density lipoprotein (LDL) 70-189 mg/dl and a 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5% based on the new pooled cohort risk score should be given statin
As patients with clinical ASCVD in 1998 were excluded, the first major recommendation group is patients with LDL ≥ 190 mg/dl (n = 153). 90.8% (n = 139) of our patients of this group were on a statin by the end of the 10-year period
Summary
Initiation of statin therapy as primary prevention in those with mildly elevated cardiovascular disease risk factors is still being debated. The 2013 ACC/AHA blood cholesterol guideline recommends initiation of statin by estimating the 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the new pooled cohort risk score. Statins have been extensively studied both in primary and secondary prevention of cardiovascular events [1,2,3,4]. Patients with clinical atherosclerotic cardiovascular disease (ASCVD) should receive statin therapy as secondary prevention. ACC/AHA guideline recommends statin therapy for patients with LDL ≥190 mg/dl. Patients without diabetes but with LDL 70-189 mg/dl and a 10-year ASCVD risk ≥7.5% based on the new pooled cohort risk score should be given statin. The pooled cohort risk equation was derived from pooled data of four large cohorts that included both white and black men and women (Framingham and the Framingham Offspring studies, Atherosclerosis Risk in Communities, Cardiovascular Health Study and Coronary Artery Risk Development in Young Adults)
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