Abstract 3411: Underidentification of Need for Statin Therapy by ATP III NCEP Risk Assessment Compared to SHAPE Guidelines
Background: Screening for Heart Attack Prevention and Education (SHAPE) guidelines ( AJC 2006;98;2–15) have proposed that atherosclerosis imaging may be superior to Framingham Risk Scores (FRS) for risk assessment and identifying need for statins.
Methods: We prospectively evaluated a consecutive series of 2,119 asymptomatic adults not on statins (mean age 58.2 years, 64% male) having coronary artery calcium (CAC) and FRS measurements and meeting SHAPE guidelines for atherosclerosis screening: age <75, >45 for men and >55 for women, ≥1 non-age CHD risk factor, no history of CHD or diabetes. Initiation of statin therapy by NCEP was based on FRS and LDL-C, whereas SHAPE also considered extent of CAC. We identified the % subjects in standard CAC groups warranting statins by SHAPE vs. NCEP.
Results: 33%, 39%, 25%, and 3% were in low, average, intermediate, and high NCEP risk groups, respectively. While % recommended for statins increased across CAC categories with both approaches, in those with detectable CAC, the increase was greater by SHAPE (graph). Overall, using SHAPE, 47% of the cohort would have statin recommendations compared with 26% by NCEP, p<0.001. In women with CAC (43%), 71% by SHAPE vs. only 16% by NCEP were identified for statins.
Conclusion: CAC screening as recommended by SHAPE identifies for statin therapy a large number of persons at potential risk of CHD who would not qualify for statins using NCEP. At the same time, by SHAPE guidelines, less than half of the population at risk would need statin treatment, suggesting the approach may be cost-effective compared to a universal treatment approach.