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

Abstract

BackgroundHealthy 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 ResultsNational 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 ASCVD 10 risk would fall 21% when ASCVD 10 risk was ≥20% and 33% when ASCVD 10 risk was <20%; and (3) either all statin‐eligible untreated adults or all with ASCVD 10 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 ASCVD 10 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).ConclusionsImplementing 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%.

Effect of Change in Total Cholesterol Levels on Cardiovascular Disease Among Young Adults

“…Although guidelines recommend high‐intensity statin treatment in adults aged >21 years with LDL‐C ≥190 mg/dL, the benefits were extrapolated from results in middle and elderly participants because of the lack of studies in young adults 23. The results from our study could add evidence that reducing cholesterol levels may be beneficial and necessary for those with high cholesterol levels to reduce CVD risk in young adults.…”

“…The author stressed the “cumulative damage hypothesis” which assumes that atherosclerotic change begins at a young age 33. However, despite American College of Cardiology/American Heart Association guidelines,23 statin prescription rates in people <40 years were estimated to be <45% among those with LDL‐C ≥190 mg/dL, which is lower than that in middle‐aged and elderly adults 34…”

Preventing Atherosclerotic Cardiovascular Disease Using American College of Cardiology and American Heart Association Prevention Guidelines: Some Good News, But Caveats Remain

“…In addition, they provide insights useful for addressing the concern noted above. Egan et al used National Health and Nutrition Examination Survey (NHANES) data to determine the impact of treating US adults based on their estimated 10‐year ASCVD risk 6. The authors determined that treating statin‐eligible untreated adults could achieve more than three‐quarters of the of the Healthy People 2020 ASCVD prevention goal.…”

High density lipoproteins and kidney function: the friend turned foe?

“…The crucial role of low density lipoprotein cholesterol (LDL-C) in cardiovascular disease (CVD) and mortality has been extensively demonstrated, and thus reducing LDL-C is one of the key therapeutic approaches for cardiovascular risk reduction (1). However, the exact role of high density lipoproteins (HDL) is still an enigma and as research expands it is getting even more complicated.…”