Impact of Heart Outcomes Prevention Evaluation Trial on Statin Eligibility for the Primary Prevention of Cardiovascular Disease
Insights from the National Health and Nutrition Examination Survey
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- cardiovascular diseases
- hydroxymethylglutaryl-CoA reductase inhibitors
- primary prevention
- waist-hip ratio
The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines suggest statin therapy for primary prevention in patients with an estimated 10-year atherosclerotic cardiovascular disease risk ≥7.5%1 as calculated by the Pooled Cohorts Equation. We recently demonstrated that only 53% of individuals eligible for statins based on the ≥7.5% risk criterion would have been eligible for a statin randomized control trial (RCT) in which benefit was demonstrated.2 We sought (1) to evaluate whether the recently published HOPE-3 trial (Heart Outcomes Prevention Evaluation)3 improves the evidence base for the ACC/AHA guidelines and (2) to estimate whether HOPE-3 increases the number of individuals eligible for statins in primary prevention beyond those recommended by the ACC/AHA guidelines.
Data from the National Health and Nutrition Examination Survey (NHANES) collected between 2005 and 2010 were used to create a sample of 2134 participants representing 71.8 million Americans without atherosclerotic cardiovascular disease who were not currently taking statins. Participants were categorized based on the following criteria: (1) a 10-year risk of ≥7.5% by Pooled Cohorts Equation; (2) an expected absolute risk reduction of ≥2.3% based on Pooled Cohorts Equation risk and individualized relative risk reductions, as previously described2; …