Preventive Cardiology

New Calculations Could Slash Statin-Eligible Population

A JAMA paper suggests that if the CVD guidelines adopt the AHA’s new PREVENT cardiovascular risk equations, it might slash the US’s eligible preventive statin user population by nearly 40%.

In November 2023 the AHA launched the PREVENT risk equations, which take into account a wider range of cardiovascular, kidney, and metabolic health measures to estimate 10- and 30-year risks of heart attack, stroke, and heart failure. 

  • The new equations notably added sex-specific risks and cardiovascular-kidney-metabolic syndrome metrics, while eliminating race since it’s not a biological factor.
  • The PREVENT calculator also represented a big change from 2013’s Pooled Cohort Equation (PCE), which was released before many CKM treatments were available, and faced criticism for overestimating CVD risks.

To evaluate PREVENT’s impact, the researchers applied the PREVENT and PCE equations to 3,785 adults aged 40 to 75 years without known ASCVD, 20.7% of whom currently take statins…

  • Patients had far lower estimated 10-year ASCVD risks with the PREVENT equations compared to the PCEs (4.3% vs. 8%).
  • The PREVENT equations’ estimated risks were lower across all age, sex, and racial subgroups.
  • PREVENT’s risk reductions were greatest among Black adults (5.1% vs. 10.9%) and people between 70 and 75 years (10.2% vs. 22.8%).
  • The PREVENT equations reclassified very few patients as higher risk for ASCVD, and most were classified to lower risk groups.

Add that all together, and transitioning to the PREVENT equations could reduce the number of Americans who meet the criteria for primary prevention statin therapy from 45.4M to 28.3M, while allowing 4.1M adults who are currently taking statins to get off their meds. 

The PREVENT equations aren’t included in the CVD guidelines yet, but their addition is expected by many, and the AHA has already launched a PREVENT calculator that’s intended for clinician use.

The Takeaway

There’s a good chance that the new PREVENT equations will have a major impact on patient care, reducing the number of low-risk patients who are prescribed statins, while hopefully increasing statin adherence among the highest-risk patients.

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