The management of high cholesterol has improved since the introduction of new guidelines followed by doctors, resulting in wider use of statins, according to a new study.
Particularly for people at medium risk, an examination of the 2013 guidelines for determining statin eligibility, compared with 2004 guidelines, suggests they provide greater accuracy and efficiency in identifying cardiovascular disease (CVD) risks.
The study by Dr. Udo Hoffmann, of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues is published in JAMA.
More participants were eligible overall for treatment with statin drugs when applying the new clinical guidance compared with the old - 39% versus 14%.
The study included participants from the offspring and third-generation cohorts of the renowned Framingham Heart Study.
Between 2002 and 2005, participants underwent multidetector computed tomography (CT) for coronary artery calcification (CAC) and were followed up for a median of 9 years for new CVD.
The average age of the 2,435 participants in the study not taking lipid-lowering therapy was 51 years. There were a total of 74 incident CVD events (3%; 40 nonfatal heart attacks, 31 nonfatal strokes and three fatal coronary heart disease events) and 43 (2%) incident coronary heart disease (CHD) events (40 nonfatal heart attacks and three fatal CHD), and:
- Among those eligible for statin treatment against the earlier guidelines, 7% developed incident CVD, compared with 2% among participants not eligible
- Applying the later guidelines, among those eligible for statin treatment, 6% developed incident CVD, compared with only 1% among those not eligible.
Improved clarity for lowering cholesterol
An editorial in the same issue of the journal says that lowering cholesterol with statins has become an "unquestionable" means for lowering cardiovascular risk, but that the question had remained of "when, in whom and how to lower cholesterol."
Dr. Philip Greenland - of the Northwestern University Feinberg School of Medicine in Chicago, and senior editor of JAMA - and Dr. Michael Lauer - of the National Heart, Lung, and Blood Institute in Bethesda, MD - say those "whom" and "how" questions have now been answered.
"Based on available evidence, including the two reports in this issue of JAMA, answers to the questions of in whom and how regarding cholesterol lowering are now more clear than they were just 18 months ago," they write, adding:
"There is no longer any question as to whether to offer treatment with statins for patients for primary prevention, and there should now be fewer questions about how to treat and in whom.
Rather, the next phase of research should be directed at better ways of applying lifestyle and drug treatments to the millions, and possibly billions, worldwide who could potentially benefit from a cost-effective approach to primary prevention of atherosclerotic cardiovascular disease."
The study authors say their findings about the appropriateness of statin eligibility were "consistent across subgroups and particularly important in participants at intermediate CVD risk on the Framingham risk scores, the most challenging group in clinical practice for whom to decide to initiate statin therapy."
Extrapolating their findings to the roughly 10 million Americans now eligible for statins, between about 41,000 and 63,000 CVD events would be prevented over 10 years if the later guidelines are adopted.
The 2013 guidelines were developed by the American College of Cardiology (ACC) with the American Heart Association (AHA). The 2004 guidelines were the National Cholesterol Education Program's Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (known as the ATP III guidelines).