Use of Statins for Primary Prevention - Selection of Risk Threshold and Implications across Race and Gender
BACKGROUND: The 2016 US Preventive Services Task Force (USPSTF) guidelines for primary prevention statin therapy are more restrictive than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. There are important differences in how application of the risk thresholds from these guidelines would impact particular segments of the US population. METHODS: Data from the National Health and Nutrition Examination Surveys (NHANES - 2005-14) were used to determine statin eligibility across age, gender and racial/ethnic groups using criteria from the 2013 ACC/AHA and 2016 USPSTF guidelines. Proportions of the study population eligible for statins under the ACC/AHA 5% and 7.5% risk thresholds were compared to those eligible under the 10% 2016 USPSTF guidelines. RESULTS: Of the 5,388 study participants, 34% were eligible for statin therapy under the USPSTF guideline, compared to 43% under the Class I (7.5%) ACA/AHA treatment threshold and 53% under the Class IIa (5%) ACA/AHA treatment threshold. Moving from the 10% USPSTF threshold to the ACC/AHA 5% threshold increased statin eligibility for males aged 40-59 from 26% to 48% (white), from 19% to 43% (Hispanic) and from 33% to 74% for blacks. A similar disproportionate but less pronounced effect was seen when different risk thresholds were used for statin eligibility among women ages 40-59 across differing race/ethnicities. CONCLUSION: In this sample of US adults from the NHANES data base, full implementation of the higher USPSTF statin treatment threshold could lead to less overall statin use, and disproportionately lower statin use among non-Hispanic blacks.
Goyal, A., Cooper, H., Aronow, W., Nagpal, P., Yandrapalli, S., Nabors, C., & Frishman, W. (2018). Use of Statins for Primary Prevention - Selection of Risk Threshold and Implications across Race and Gender. The American Journal of Medicine, 131 (10), 1234-1237. https://doi.org/10.1016/j.amjmed.2018.05.029