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2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

View Article: PubMed Central - PubMed

ABSTRACT

Background: Healthy People 2020 aim to reduce fatal atherosclerotic cardiovascular disease (ASCVD) by 20%, which translates into 310 000 fewer events annually assuming proportional reduction in fatal and nonfatal ASCVD. We estimated preventable ASCVD events by implementing the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Cholesterol Guideline in all statin‐eligible adults. Absolute risk reduction (ARR) and number needed‐to‐treat (NNT) were calculated.

Methods and results: National Health and Nutrition Examination Survey data for 2007–2012 were analyzed for adults aged 21 to 79 years and extrapolated to the US population. Literature‐guided assumptions were used including (1) low‐density lipoprotein cholesterol falls 33% with moderate‐intensity statins and 51% with high‐intensity statins; (2) for each 39 mg/dL decline in low‐density lipoprotein cholesterol, 10‐year ASCVD10 risk would fall 21% when ASCVD10 risk was ≥20% and 33% when ASCVD10 risk was <20%; and (3) either all statin‐eligible untreated adults or all with ASCVD10 risk ≥7.5% would receive statins. Of 175.9 million adults aged 21 to 79 years not taking statins, 44.8 million (25.5%) were statin eligible. Treating all statin‐eligible adults would prevent an estimated 243 589 ASCVD events annually (ARR 5.4%, 10‐year NNT 18). Treating all statin‐eligible adults with ASCVD10 risk ≥7.5% reduces the number treated to 32.2 million (28.2% fewer), whereas ASCVD events prevented annually fall only 10.5% to 217 974 (6.8% ARR, NNT 15).

Conclusions: Implementing the ACC/AHA 2013 Cholesterol Guideline in all untreated, statin‐eligible adults could achieve ≈78% of the Healthy People 2020 ASCVD prevention goal. Most of the benefit is attained by individuals with 10‐year ASCVD risk ≥7.5%.

No MeSH data available.


Flow diagram showing derivation of the study sample with numbers and reasons for exclusion from consideration for statin therapy (left). Among adults not taking statins, the numbers of statin‐ineligible and eligible adults are also shown (right).
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jah31628-fig-0001: Flow diagram showing derivation of the study sample with numbers and reasons for exclusion from consideration for statin therapy (left). Among adults not taking statins, the numbers of statin‐ineligible and eligible adults are also shown (right).

Mentions: As shown in Figure 1, fewer than half of adult participants in NHANES provided fasting blood samples. Total cholesterol and high‐density lipoprotein cholesterol (HDL‐C) were measured on all participants regardless of fasting status, whereas triglycerides were measured and LDL‐C calculated only from fasting samples. For patients with triglyceride levels >400 mg/dL (n=128, representing 3 627 587 US adults [aged 21–79 years]), LDL‐C was not calculated. Total cholesterol of 40 to 800 mg/dL, HDL‐C of 2 to 140 mg/dL, LDL‐C of 20 to 700 mg/dL, and triglycerides of 20 to 12 000 mg/dL were accepted as valid.


2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals
Flow diagram showing derivation of the study sample with numbers and reasons for exclusion from consideration for statin therapy (left). Among adults not taking statins, the numbers of statin‐ineligible and eligible adults are also shown (right).
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015284&req=5

jah31628-fig-0001: Flow diagram showing derivation of the study sample with numbers and reasons for exclusion from consideration for statin therapy (left). Among adults not taking statins, the numbers of statin‐ineligible and eligible adults are also shown (right).
Mentions: As shown in Figure 1, fewer than half of adult participants in NHANES provided fasting blood samples. Total cholesterol and high‐density lipoprotein cholesterol (HDL‐C) were measured on all participants regardless of fasting status, whereas triglycerides were measured and LDL‐C calculated only from fasting samples. For patients with triglyceride levels >400 mg/dL (n=128, representing 3 627 587 US adults [aged 21–79 years]), LDL‐C was not calculated. Total cholesterol of 40 to 800 mg/dL, HDL‐C of 2 to 140 mg/dL, LDL‐C of 20 to 700 mg/dL, and triglycerides of 20 to 12 000 mg/dL were accepted as valid.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Healthy People 2020 aim to reduce fatal atherosclerotic cardiovascular disease (ASCVD) by 20%, which translates into 310 000 fewer events annually assuming proportional reduction in fatal and nonfatal ASCVD. We estimated preventable ASCVD events by implementing the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Cholesterol Guideline in all statin‐eligible adults. Absolute risk reduction (ARR) and number needed‐to‐treat (NNT) were calculated.

Methods and results: National Health and Nutrition Examination Survey data for 2007–2012 were analyzed for adults aged 21 to 79 years and extrapolated to the US population. Literature‐guided assumptions were used including (1) low‐density lipoprotein cholesterol falls 33% with moderate‐intensity statins and 51% with high‐intensity statins; (2) for each 39 mg/dL decline in low‐density lipoprotein cholesterol, 10‐year ASCVD10 risk would fall 21% when ASCVD10 risk was ≥20% and 33% when ASCVD10 risk was <20%; and (3) either all statin‐eligible untreated adults or all with ASCVD10 risk ≥7.5% would receive statins. Of 175.9 million adults aged 21 to 79 years not taking statins, 44.8 million (25.5%) were statin eligible. Treating all statin‐eligible adults would prevent an estimated 243 589 ASCVD events annually (ARR 5.4%, 10‐year NNT 18). Treating all statin‐eligible adults with ASCVD10 risk ≥7.5% reduces the number treated to 32.2 million (28.2% fewer), whereas ASCVD events prevented annually fall only 10.5% to 217 974 (6.8% ARR, NNT 15).

Conclusions: Implementing the ACC/AHA 2013 Cholesterol Guideline in all untreated, statin‐eligible adults could achieve ≈78% of the Healthy People 2020 ASCVD prevention goal. Most of the benefit is attained by individuals with 10‐year ASCVD risk ≥7.5%.

No MeSH data available.