About 40 percent of the people currently advised to take statins would not be if they were assessed using new criteria, according to a study published on June 10 in JAMA Internal Medicine.
In 2023, the American Heart Association developed a risk assessment to evaluate a person’s risk of heart disease. The assessment, PREVENT, significantly reduces the number of people who must take statins to prevent heart disease.
“We don’t want people to think they were treated incorrectly in the past. They were treated with the best data we had when the PCE (a cardiovascular risk calculator) was introduced back in 2013,” Dr. Timothy Anderson, lead author of the study, said in a statement. “The data have changed.”
Dr. Anderson noted that a person’s risk of developing atherosclerotic cardiovascular disease can change over time.
“For a patient who we now know is at lower risk than we previously thought, if we recommend they stop taking statins, they still could be back to a higher risk five years down the road, for the simple reason that everybody’s risk goes up as we get older,” he said.
What Is PREVENT?
The PREVENT equation is a risk calculator created by the American Heart Association to predict people’s 10-year risk of atherosclerosis. While a tool already existed—the pooled cohort equation (PCE)—there were concerns that the PCE, which predicts risks based on sex- and race-specific factors, may overestimate cardiovascular risk because of underrepresentation in certain cohorts.
Unlike PCEs, PREVENT accounts for clinical factors, including cardiovascular and kidney issues, recognizing the link between cardiovascular, kidney, and metabolic health. Also, unlike PCE, PREVENT does not take race and ethnicity into consideration.
PREVENT was developed to determine risks within the current population more accurately, as the PCE was based on patient data from the 1940s to the 1980s.
Fewer Adults Need Statins
In the newest study comparing the 2013 PCE guidelines with the PREVENT equation, Dr. Anderson and his team found that the number of adults for whom statins are recommended could decrease to 28.3 million from 45.4 million and that roughly 4.1 million patients currently taking statins would no longer be advised to take them.The researchers looked at data from 3,785 adults between the ages of 40 and 75 who were part of the National Health and Nutrition Examination Survey (NHANES) between January 2017 and March 2020.
Under the PREVENT criteria, the study’s entire cohort was half as likely to develop atherosclerotic cardiovascular disease, with overall rates dropping to 4 percent from 8 percent.
The difference was the greatest for black adults, with risks decreasing to 5.1 percent from 10.9 percent. Black people between 70 and 75 saw a risk reduction to 10.2 percent from 22.8 percent.
The authors wrote that the adoption of PREVENT may substantially reduce overmedication.
“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” Dr. Anderson said.
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