Abstract P308: Individualized Statin Benefit for Determining Statin Eligibility in the Primary Prevention of Cardiovascular Disease
Background: Current guidelines recommend statins in primary prevention of cardiovascular disease based on predicted cardiovascular risk without directly considering the expected benefits of statin therapy based on the available randomized trial (RCT) evidence.
Methods and Results: We included 2,134 participants representing 71.8 million American residents potentially eligible for statins in primary prevention from the National Health and Nutrition Examination Survey for years 2005 - 2010. We compared statin eligibilities using three separate approaches: a 10-year risk-based approach, a trials-based approach (i.e. based on inclusion criteria of statin RCTs) and an individualized benefit approach (i.e. based on a predicted absolute risk reduction over 10 years [ARR10] ≥2.5% using RCT data). A risk-based, a trials-based approach or a benefit-based approach led to the eligibility of (in millions of Americans): 15.0 (95% confidence interval 13.3-16.8), 24.7 (22.4-27.0) and 24.0 (21.2-26.7), respectively. The corresponding number needed to treat over 10 years was 19 (range: 9-40), 33 (9-1000) and 23 (9-40). A benefit-based approach identified 8.9 million lower-risk (<7.5% 10 year risk) Americans, not currently eligible for statin treatment, who had the same or greater expected benefit from statins (≥2.5% ARR10) as higher-risk individuals. This lower-risk/acceptable-benefit group includes younger individuals (mean age 55.3 years vs. 62.5 years;p<0.001 for benefit-based vs risk-based) with higher LDL-C (140 mg/dL vs. 133 mg/dL; p=0.01).
Conclusions: An individualized statin benefit approach can identify lower-risk individuals who have equal or greater expected benefit from statins in primary prevention than higher-risk individuals. This may help identify individuals who would meaningfully benefit from earlier initiation of statin therapy.
Author Disclosures: G. Thanassoulis: B. Research Grant; Significant; Isis Pharmaceuticals. C. Other Research Support; Significant; Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada. D. Speakers Bureau; Modest; Servier Canada. G. Consultant/Advisory Board; Modest; Isis Pharmaceuticals, Servier Canada. K. Williams: None. K.K. Altobelli: None. M.J. Pencina: None. C.P. Cannon: None. A.D. Sniderman: None. A.D. Sniderman: None.
- © 2016 by American Heart Association, Inc.