Gupta Kartik, Kakar Tanya S, Jain Vardhmaan, Gupta Mohak, Al Rifai Mahmoud, Slipczuk Leandro, Nambi Vijay, Bittner Vera, Blumenthal Roger S, Stone Neil J, Lavie Carl J, Virani Salim S
Henry Ford Hospital, Detroit, MI, USA.
Emory University School of Medicine, Atlanta, GA, USA.
Prog Cardiovasc Dis. 2022 Nov-Dec;75:78-82. doi: 10.1016/j.pcad.2022.08.007. Epub 2022 Aug 28.
The United States Preventive Services Taskforce (USPSTF) recently released recommendations for statin therapy eligibility for the primary prevention of cardiovascular disease (CVD). We report the proportion and the absolute number of US adults who would be eligible for statin therapy under these recommendations and compare them with the previously published 2018 American Heart Association (AHA)/ American College of Cardiology (ACC)/ Multisociety (MS) Cholesterol guidelines.
We used data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 of adults aged 40-75 years without prevalent self-reported atherosclerotic CVD (ASCVD) and low-density lipoprotein-cholesterol <190 mg/dL. The 2022 USPSTF recommends statin therapy for primary prevention in those with a 10-year ASCVD risk of ≥10% and ≥ 1 CVD risk factor (diabetes mellitus, dyslipidemia, hypertension, or smoking). The 2018 AHA/ ACC/ MS Cholesterol guideline recommends considering statin therapy for primary prevention for those with diabetes mellitus, or 10-year ASCVD risk ≥20% or 10-year ASCVD risk 7.5 to <20% after accounting for risk-enhancers and shared decision making. Survey recommended weights were used to project these proportions to national estimates.
Among 1799 participants eligible for this study, the weighted mean age was 56.0 ± 0.5 years, with 53.0% women (95% confidence interval [CI] 49.7, 56.3), and 10.6% self-reported NH Black individuals (95% CI 7.7, 14.3). The weighted mean 10-year ASCVD risk was 9.6 ± 0.3%. The 2022 USPSTF recommendations and the 2018 AHA/ ACC/ MS Cholesterol guidelines indicated eligibility for statin therapy in 31.8% (95% CI 28.6, 35.1) and 46.8% (95% CI 43.0, 50.5) adults, respectively. These represent 33.7 million (95% CI 30.4, 37.2) and 49.7 million (95% CI 45.7, 53.7) adults, respectively. For those with diabetes mellitus, 2022 USPSTF recommended statin therapy in 63.0% (95% CI 52.1, 72.7) adults as compared with all adults with diabetes aged 40-75 years under the 2018 AHA/ ACC/ MS Cholesterol guidelines.
In this analysis of the nationally representative US population from 2017 to 2020, approximately 15% (~16.0 million) fewer adults were eligible for statin therapy for primary prevention under the 2022 USPSTF recommendations as compared to the 2018 AHA/ ACC/ MS Cholesterol guideline.
美国预防服务工作组（USPSTF）最近发布了关于他汀类药物治疗用于心血管疾病（CVD）一级预防的资格建议。我们报告了根据这些建议符合他汀类药物治疗资格的美国成年人的比例和绝对数量，并将其与先前发布的2018年美国心脏协会（AHA）/美国心脏病学会（ACC）/多学会（MS）胆固醇指南进行比较。
我们使用了2017 - 2020年国家健康和营养检查调查（NHANES）中40 - 75岁成年人的数据，这些成年人无自我报告的动脉粥样硬化性心血管疾病（ASCVD）且低密度脂蛋白胆固醇<190 mg/dL。2022年USPSTF建议，对于10年ASCVD风险≥10%且有≥1个心血管疾病风险因素（糖尿病、血脂异常、高血压或吸烟）的人群进行一级预防时使用他汀类药物治疗。2018年AHA/ACC/MS胆固醇指南建议，对于糖尿病患者，或10年ASCVD风险≥20%，或在考虑风险增强因素并进行共同决策后10年ASCVD风险为7.5%至<20%的人群，考虑进行一级预防时使用他汀类药物治疗。调查推荐权重用于将这些比例推算为全国估计值。
在1799名符合本研究条件的参与者中，加权平均年龄为56.0±0.5岁，女性占53.0%（95%置信区间[CI]49.7, 56.3），自我报告为非裔美国人的占10.6%（95%CI 7.7, 14.3）。加权平均10年ASCVD风险为9.6±0.3%。2022年USPSTF建议和2018年AHA/ACC/MS胆固醇指南分别表明，31.8%（95%CI 28.6, 35.1）和46.8%（95%CI 43.0, 50.5）的成年人符合他汀类药物治疗资格。这些分别代表3370万（95%CI 3040, 3720）和4970万（95%CI 4570, 5370）成年人。对于糖尿病患者，2022年USPSTF建议63.0%（95%CI 52.1, 72.7）的成年人使用他汀类药物治疗，而2018年AHA/ACC/MS胆固醇指南适用于所有40 - 75岁的糖尿病成年人。
在对2017年至2020年具有全国代表性的美国人群的分析中，与2018年AHA/ACC/MS胆固醇指南相比，根据2022年USPSTF建议，符合他汀类药物一级预防治疗资格的成年人减少了约15%（约1600万）。
