Author + information
- Received July 30, 2015
- Revision received September 24, 2015
- Accepted September 25, 2015
- Published online December 22, 2015.
- Martin B. Mortensen, MD, PhD∗,
- Shoaib Afzal, MD, PhD†,‡,
- Børge G. Nordestgaard, MD, DMSc†,‡∗ ( and )
- Erling Falk, MD, DMSc∗
- ∗Atherosclerosis Research Unit, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- †Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- ‡Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- ↵∗Reprint requests and correspondence:
Dr. Børge G. Nordestgaard, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
Background Guidelines recommend initiating primary prevention for atherosclerotic cardiovascular disease (ASCVD) with statins based on absolute ASCVD risk assessment. Recently, alternative trial-based and hybrid approaches were suggested for statin treatment eligibility.
Objectives This study compared these approaches in a direct head-to-head fashion in a contemporary population.
Methods The study used the CGPS (Copenhagen General Population Study) with 37,892 subjects aged 40 to 75 years recruited in 2003 to 2008, all free of ASCVD, diabetes, and statin use at baseline.
Results Among the population studied, 42% were eligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) risk assessment and cholesterol treatment guidelines approach, versus 56% with the trial-based approach and 21% with the hybrid approach. Among these statin-eligible subjects, the ASCVD event rate per 1,000 person-years was 9.8, 6.8, and 11.2, respectively. The ACC/AHA-recommended absolute risk score was well calibrated around the 7.5% 10-year ASCVD risk treatment threshold and discriminated better than the trial-based or hybrid approaches. Compared with the ACC/AHA risk-based approach, the net reclassification index for eligibility for statin therapy among 40- to 75-year-old subjects from the CGPS was –0.21 for the trial-based approach and –0.13 for the hybrid approach.
Conclusions The clinical performance of the ACC/AHA risk-based approach for primary prevention of ASCVD with statins was superior to the trial-based and hybrid approaches. Our results indicate that the ACC/AHA guidelines will prevent more ASCVD events than the trial-based and hybrid approaches, while treating fewer people compared with the trial-based approach.
This work was supported by Herlev and Gentofte Hospital, Copenhagen University Hospital, the Copenhagen County Foundation, and Aarhus University. The funding organizations had no role in any of the following: design and conduct of the study; collection, analysis, and interpretation of the data; or the preparation, review, and approval of the manuscript. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 30, 2015.
- Revision received September 24, 2015.
- Accepted September 25, 2015.
- 2015 American College of Cardiology Foundation