Dueling Statin Guidelines Put 9 Million Americans at Crossroads

Two groups recommend the drugs, but diverge on who needs them and when

DURHAM, N.C. April 18, 2017 – Dueling guidelines for the use of statins to prevent cardiovascular disease have fed confusion, but this much is now known: If all doctors followed advice from the U.S. Preventive Services Task Force, 9 million fewer adults would be taking the drug than if they adhered to the American College of Cardiology/American Heart Association recommendations.

The analysis by the Duke Clinical Research Institute also finds that most of those who would be dropped from the USPSTF guidelines are younger adults.

“Having multiple guidelines out there for cholesterol-lowering drugs can be confusing to physicians and patients,” said Duke’s Neha J. Pagidipati, M.D., lead author of a study published April 18 in the Journal of the American Medical Association. “Until we get more definitive answers about the optimal approach, the best we can do is understand the pros and cons of each set of guidelines. Our study adds some of that context.”

Pagidipati and colleagues — including senior author Michael J. Pencina, Ph.D., professor of biostatistics and bioinformatics at DCRI — analyzed the most recent-available six-year data from the National Health and Nutrition Examination Survey, a representative sample of U.S. residents that provides key health statistics over time.

The researchers estimated that, if fully implemented, the USPSTF recommendations would result in a 15.8 percent rise in the use of statins among U.S. adults aged 40 through 75 with no prior cardiovascular disease. Those newly recommended for statins would be in addition to the 21.5 percent of U.S. adults already taking the lipid-lowering therapy.

By comparison, the ACC/AHA guidelines would result in an additional 24.3 percent of U.S. adults beginning on statins.

“We estimate there could be a 9 million fewer individuals recommended for statin therapy under the USPSTF recommendations compared with the ACC/AHA guidelines,” Pagidipati said.

The Duke researchers found that of those who are recommended to receive statins by the ACC/AHA but not the USPSTF, over half are younger adults aged 40 to 59 years, and over a quarter are people with diabetes.

“Even though younger people have a modest short-term risk of developing cardiovascular disease in 10 years, the risk escalates over 30 years,” Pencina said. “Half of all cardiovascular events in men and one-third in women occur before the age of 65 years, so reliance on 10-year risk could miss many younger people who could potentially benefit from long-term statin therapy.”

In addition to Pencina and Pagidipati, study authors include Ann Marie Navar, Hillary Mulder, Allan D. Sniderman, and Eric D. Peterson.

The study received support from the Duke Clinical Research Institute.

SOURCE: Duke Health