Statin Therapy Recipients Increase Under ACC/AHA Guidelines

A recent study showed statin therapy decreased relative cardiovascular risk by 25% [Database Syst Rev. 2013;1:CD004816]. In 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) made recommendations for cholesterol management that altered previous recommendations made by ATP-III (Third Adult Treatment Panel of the National Cholesterol Education Program).

The study used data from the National Health and Nutrition Examination Surveys (NHANES) between 2005 and 2010 to represent a sample of the noninstitutionalized US population. From there, the study was able to estimate the number of patients in the United States who would be newly eligible for statin therapy under the ACC/AHA guidelines compared to individuals previously eligible under the ATP-III guidelines.

The sample size consisted of 3773 participants, of whom 2135 (56.6%) would be eligible for statin therapy under the ACC/AHA guidelines, 599 (15.9%) who are eligible for the first time due to the modifications in the ACC/AHA guidelines compared to the 1583 (42%) who would be eligible under the ATP-III guidelines.

Extrapolating this data to the US population, under the ACC/AHA recommendations, an estimated 56 million adults (48.6%; 95% confidence interval [CI], 46.3-51) would be eligible to receive statin treatment, 14.4 million of the adults being newly eligible compared to 43.2 million adults (37.5%; 95% CI, 35.3-39.7) who are eligible under ATP-III guidelines. This results in a net increase of 12.8 million adults eligible for statin therapy. The majority of the 43.2 million to 56 million increase is contributed to adults without CVD (10.4 million).

Of the 14.4 million people newly eligible for statin treatment under the ACC/AHA guidelines, 61.7% would be male, have a median age of 63.4 years, and a median LDL cholesterol level of 105.2 mg/dL.

Across all therapies, the ACC/AHA guidelines would increase the estimated number of adults who qualify for statin therapy, although, it is adults who indicated primary prevention, on the basis of their 10-year risk of CVD, that represented the largest increase in eligibility. The number of adults who qualify for statin therapy would increase from 6.9 million to 15.1 million under ACC/AHA guidelines.

There would also be a substantial number of adults with CVD and LDL cholesterol levels <100 mg/dL—2.4 million—who would be ineligible for statin treatment under ATP-III guidelines but would qualify under ACC/AHA. Under ATP-III recommendations, an estimated 4.5 million adults with diabetes would be eligible for statin therapy; however, an estimated 6.7 million would qualify under ACC/AHA. 

The number of adults without CVD who would be eligible for statins in the 40 to 59 years of age group is comparable; 27% and 29.7% for ATP-III guidelines and ACC/AHA guidelines, respectively. However the same cannot be said for the 60 to 75 years of age group, in which more people without CVD would be eligible for statin therapy under the ACC/AHA guidelines rather than the ATP-III guidelines (77.3% vs 47.8%).

Under the ACC/AHA guidelines, the majority of the increase in eligible patients can be attributed to the 60 to 76 years of age group, who would benefit most from the implementation of ACC/AHA guidelines, according to the researchers.