New Risk Assessment Suggest Fewer Americans Would Take Statins: Report

By Amie Dahnke

A new way of predicting cardiovascular risks suggests that 40 percent fewer people need to be on statins to prevent heart disease, according to a Monday study published in JAMA Internal Medicine.

“We don’t want people to think they were treated incorrectly in the past. They were treated with the best data we had when the PCE (a cardiovascular risk calculator) was introduced back in 2013,” Dr. Timothy Anderson, lead author of the study, said in a news release. “The data have changed,” he added.

Dr. Anderson noted that a person’s risk of developing atherosclerotic cardiovascular disease can change over time.

“For a patient who we now know is at lower risk than we previously thought, if we recommend they stop taking statins, they still could be back to a higher risk five years down the road, for the simple reason that everybody’s risk goes up as we get older,” he said.

The study compared the American Heart Association’s (AHA) 2023 guidelines to the 2013 American College of Cardiology guidelines. The AHA’s most recent guidelines, which use PREVENT, a new risk-assessing equation, found that fewer people may need to take statins, a cholesterol-lowering drug.

What Is PREVENT?

The PREVENT equation is a risk calculator created by the American Heart Association to predict people’s 10-year risk of atherosclerosis. While a tool already existed—the pooled cohort equation (PCE)—there were concerns that the PCE, which predicts risks based on sex- and race-specific factors, may overestimate cardiovascular risk due to underrepresentation in certain cohorts.

Unlike PCEs, PREVENT accounts for clinical factors, including cardiovascular and kidney issues, recognizing the link between cardiovascular, kidney, and metabolic health. Also, unlike PCE, PREVENT does not take race and ethnicity into consideration.

PREVENT was developed to determine risks within the current population more accurately, as the PCE was based on patient data from the 1940s to the 1980s.

The AHA developed the equation in November 2023 and offered it as a way to “be applied in a broad range of clinical and community settings,” noting in its journal that it can “be implemented by all clinicians who care for adult patients, including primary care, obstetrics and gynecology, cardiology, nephrology, and endocrinology settings.”

However, the authors wrote that they do not know if PREVENT’s risk score is more accurate than PCE’s in today’s practice.

Fewer Adults Need Statins

In the newest study comparing the 2013 PCE guidelines to the PREVENT equation, Dr. Anderson and his team found that the number of adults recommended for statins could decrease from 45.4 million to 28.3 million and that roughly 4.1 million patients currently taking statins would no longer be advised to take them.

The researchers looked at data from 3,785 adults between the ages of 40 and 75 who were part of the National Health and Nutrition Examination Survey (NHANES) between January 2017 and March 2020.

Under the PREVENT criteria, the study’s entire cohort was half as likely to develop atherosclerotic cardiovascular disease, with overall rates dropping from 8 percent to 4 percent.

The difference was the greatest for black adults, with risks decreasing from 10.9 percent to 5.1 percent. Black people between 70 and 75 saw a risk reduction from 22.8 percent to 10.2 percent.

The authors wrote that the adoption of PREVENT may substantially reduce overmedication.

According to a 2023 study, nearly one in five Americans report taking some sort of statin. The number of prescriptions for statins has almost doubled in a decade, rising from 461 million in 2008 to 818 million in 2019.

“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” said Dr. Anderson.