Compared to the 2013 ACC/AHA guidelines for statin therapy, following the 2016 USPSTF recommendations could result in a smaller number of patients recommended for primary prevention statin therapy, according to a study published in JAMA. 

Existing guideline recommendations have varying positions on statin use for primary prevention. The 2016 USPSTF recommendations focus on therapy based on ≥1 cardiovascular disease (CVD) risk factors and a 10-year global CVD risk of ≥10%.

Neha J. Pagidipati, MD, MPH, and colleagues from Duke University, Durham, NC, aimed to assess the difference in patient eligibility for primary prevention statin treatment among U.S. adults from 2009–2015 assuming full adherence to the USPSTF recommendations vs. ACC/AHA guidelines. The patient sample included 3,416 adults aged 40–75 years with available fasting lipid data and triglyceride levels ≤400mg/dL without prior CVD. 

Approximately 22% of patients were already taking lipid-lowering drugs. Full application of the USPSTF recommendations would be associated with statin therapy initiation in another 15.8% (95% CI: 14–17.5) of patients vs. another 24.3% (95% IC: 22.3–26.3) of patients with full application of the 2013 ACC/AHA guidelines. 

Of the 8.9% of patients in the primary prevention population that would be recommended for statin therapy under the ACC/AHA guidelines but not by USPSTF recommendations, the authors found 55% would be adults aged 40–59 years with a mean CVD risk >30%. Moreover, 28% of those patients would have diabetes

Overall, full implementation of the 2016 USPSTF recommendations could result in less individuals initiating statin therapy for primary prevention vs. the 2013 ACC/AHA guidelines, including a proportion of younger adults with high mean long-term CVD risk.

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