The American Heart Association's new cardiovascular disease event prediction equations could leave 14.3 million patients ineligible for statin therapy, according to a study published July 29 in JAMA.
The AHA and the American College of Cardiology have recommended using pooled cohort equations to predict a patient's 10-year risk of cardiovascular disease since 2013. Recently, a scientific advisory group at the AHA developed a new prediction tool, Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations.
PREVENT removes race as an input, incorporates kidney measures and improves "calibration in contemporary populations," the study said. These changes contribute to lower CVD risk predictions compared to PCEs. Risk prediction levels can influence patient eligibility for certain treatments and overall clinical outcomes.
Researchers from academic institutions across the U.S. studied data from National Health and Nutrition Examination Surveys to predict patients' 10-year cardiovascular disease risk using PCEs and PREVENT equations, then compared the results.
The data analyzed for the study was from 7,765 adults ages 30 to 79, surveyed between 2011 and 2020. The data included only patients without prior myocardial infarction, stroke or heart failure.
According to researchers, using the PREVENT equations would decrease the number of U.S. adults eligible for statin therapy by 14.3 million. PREVENT also would decrease the number of U.S. adults receiving antihypertensive therapy by 2.62 million. Researchers estimate this reduction in treatment eligibility could result in 107,000 more cardiovascular events, such as myocardial infarction or stroke.
There is no current recommendation to replace PCEs with PREVENT, but the AHA has proposed including it in future guidelines.
"Although PREVENT advances the important goal of more accurate and precise cardiovascular risk prediction, the magnitude of these projected changes warrants careful reconsideration of current treatment thresholds using decision-analytic or cost-effectiveness frameworks," researchers said.
A study published by researchers at the University of Pittsburgh in JAMA Internal Medicine in June found that 40% fewer people would meet the criteria for a statin prescription under PREVENT guidelines.