Author + information
- Fernando H.Y. Cesena,
- Antonio Laurinavicius,
- Viviane Tabone,
- Raquel Conceicao,
- Marcio Bittencourt and
- Raul Santos
Background: Current recommendation for statin initiation considers the absolute cardiovascular (CV) risk and not the predicted CV benefit. We evaluated the impact of a benefit-based strategy (Benef-S) on statin eligibility and estimated CV benefit, compared to a risk-based strategy (Risk-S), in primary prevention of CV disease.
Methods: We selected individuals 40-75 years of age, with LDL-c 70-<190 mg/dL, no previous CV disease or diabetes, not on lipid-lowering drugs, who underwent a routine health screening. Statin benefit was estimated assuming a 40% LDL-c reduction and a 22% relative risk reduction of major CV events for each 39 mg/dL LDL-c reduction. In the Risk-S, criterion for statin eligibility was 10-year atherosclerotic CV disease (ASCVD) risk ≥7.5%. In the Benef-S, individuals were considered for statin according to the estimated absolute CV risk reduction, so that the number of statin candidates was the same as in the Risk-S.
Results: The study comprised 16008 subjects (48 ± 6 years, 75% men). Among statin candidates allocated in the Risk-S, 11% would be replaced, in the Benef-S, by younger subjects with higher LDL-c and lower ASCVD risk. The Table shows subgroup analyses.
Conclusions: Replacing the Risk-S by the Benef-S, while keeping the same rate of statin use in the population, promotes substantial changes in statin eligibility in subjects at intermediate CV risk, transferring part of the CV benefit from higher to lower risk individuals, but not modifying the overall CV benefit in the population.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Advances in Cholesterol Measurement and Management
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1106-042
- 2017 American College of Cardiology Foundation