Pagidipati Neha J, Navar Ann Marie, Mulder Hillary, Sniderman Allan D, Peterson Eric D, Pencina Michael J
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
McGill University Health Centre, Montreal, Canada.
JAMA. 2017 Apr 18;317(15):1563-1567. doi: 10.1001/jama.2017.3416.
There are important differences among guideline recommendations for using statin therapy in primary prevention. New recommendations from the US Preventive Services Task Force (USPSTF) emphasize therapy based on the presence of 1 or more cardiovascular disease (CVD) risk factors and a 10-year global CVD risk of 10% or greater.
To determine the difference in eligibility for primary prevention statin treatment among US adults, assuming full application of USPSTF recommendations compared with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines.
DESIGN, SETTING, AND PARTICIPANTS: National Health and Nutrition Examination Survey (NHANES) data (2009-2014) were used to assess statin eligibility under the 2016 USPSTF recommendations vs the 2013 ACC/AHA cholesterol guidelines among a nationally representative sample of 3416 US adults aged 40 to 75 years with fasting lipid data and triglyceride levels of 400 mg/dL or less, without prior CVD.
The 2016 USPSTF recommendations vs 2013 ACC/AHA guidelines.
Eligibility for primary prevention statin therapy.
Among the US primary prevention population represented by 3416 individuals in NHANES, the median weighted age was 53 years (interquartile range, 46-61), and 53% (95% CI, 52%-55%) were women. Along with the 21.5% (95% CI, 19.3%-23.7%) of patients who reported currently taking lipid-lowering medication, full implementation of the USPSTF recommendations would be associated with initiation of statin therapy in an additional 15.8% (95% CI, 14.0%-17.5%) of patients, compared with an additional 24.3% (95% CI, 22.3%-26.3%) of patients who would be recommended for statin initiation under full implementation of the 2013 ACC/AHA guidelines. Among the 8.9% of individuals in the primary prevention population who would be recommended for statins by ACC/AHA guidelines but not by USPSTF recommendations, 55% would be adults aged 40 to 59 years with a mean 30-year cardiovascular risk greater than 30%, and 28% would have diabetes.
In this sample of US adults from 2009-2014, adherence to the 2016 USPSTF recommendations for statin therapy, compared with the 2013 ACC/AHA guidelines, could lead to a lower number of individuals recommended for primary prevention statin therapy, including many younger adults with high mean long-term CVD risk.
在他汀类药物用于一级预防的指南建议方面存在重要差异。美国预防服务工作组（USPSTF）的新建议强调基于存在1种或更多种心血管疾病（CVD）危险因素以及10年全球CVD风险达到10%或更高来进行治疗。
假设完全应用USPSTF建议与美国心脏病学会/美国心脏协会（ACC/AHA）指南相比，确定美国成年人中一级预防他汀类药物治疗的适用资格差异。
设计、设置和参与者：使用国家健康和营养检查调查（NHANES）数据（2009 - 2014年），在3416名年龄在40至75岁、有空腹血脂数据且甘油三酯水平为400mg/dL或更低、无既往CVD的具有全国代表性的美国成年人样本中，评估2016年USPSTF建议与2013年ACC/AHA胆固醇指南下的他汀类药物适用资格。
2016年USPSTF建议与2013年ACC/AHA指南。
一级预防他汀类药物治疗的适用资格。
在NHANES中由3416人代表的美国一级预防人群中，加权年龄中位数为53岁（四分位间距，46 - 61岁），53%（95%CI，52% - 55%）为女性。除了21.5%（95%CI，19.3% - 23.7%）报告目前正在服用降脂药物的患者外，与在完全实施2013年ACC/AHA指南时会被推荐开始使用他汀类药物的另外24.3%（95%CI，22.3% - 26.3%）的患者相比，完全实施USPSTF建议还会使另外15.8%（95%CI，14.0% - 17.5%）的患者开始使用他汀类药物治疗。在一级预防人群中，8.9%的个体被ACC/AHA指南推荐使用他汀类药物但未被USPSTF建议推荐，其中55%为年龄在40至59岁、平均30年心血管风险大于30%的成年人，28%患有糖尿病。
在这个2009 - 2014年的美国成年人样本中，与2013年ACC/AHA指南相比，遵循2016年USPSTF他汀类药物治疗建议可能会使被推荐进行一级预防他汀类药物治疗的个体数量减少，包括许多平均长期CVD风险高的年轻成年人。
