Study: ACC/ACH Guidelines Improve Detection of CVD

According to a recent study, the 2013 cholesterol guidelines set out by the American College of cardiology/American Heart Association (ACC/AHA) improved detection rates of those with heightened risk for developing cardiovascular disease (CVD). Further, the 10-year CVD risk threshold for primary prevention statin treatment outlined in the guidelines is cost effective and could even be lowered, according to a second study.

For the first study—a longitudinal community-based cohort—participants underwent multidetector computed tomography for coronary artery calcification (CAC) with an average follow-up of 9.4 years for incident CVD.
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Researchers defined their objective as, “ To determine whether the ACC/AHA guidelines improve identification of individuals who develop incident cardiovascular disease (CVD) and/or have coronary artery calcification (CAC) compared with the National Cholesterol Education Program’s 2004 Updated Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) guidelines.”¹

Of the 2435 statin-naïve participants, 39% (941) were found to meet statin eligibility requirements as dictated by the ACC/AHA guidelines compared to 14%(348) using the ATP III criteria. Overall, 74 CVD events were reported: 3 fatal coronary heart disease events, 40 non-fatal myocardial infarctions, and 31 nonfatal ischemic strokes.¹

Further, researchers discovered that patients who were newly statin eligible (24%) had a 5.7% incident CVD rate. Those with CAC had a higher likelihood of being statin eligible by the ACC/AHA standards compared to ATP III guidelines.¹

In the second study, using a microsimulation model, researchers determined that the current atherosclerotic cardiovascular disease (ASCVD) threshold of 7.5% or higher, linked to 48% of adults treated with statins, had an incremental cost-effectiveness ratio (ICER) of $37,000 per quality-adjusted life-year (QALY) compared to a 10% or greater threshold.²

“In this microsimulation model of US adults aged 45 to 70 years, the current 10-year ASCVD risk threshold (≥7.5% risk threshold) used in the ACC/AHA cholesterol treatment guidelines has an acceptable cost-effectiveness profile (ICER, $37 000/QALY), but more lenient ASCVD thresholds would be optimal using cost-effectiveness thresholds of $100 000/QALY (≥4.0% risk threshold) or $150 000/QALY (≥3.0% risk threshold),”² said the study’s researchers.

“The optimal ASCVD threshold was sensitive to patient preferences for taking a pill daily, changes to statin price, and the risk of statin-induced diabetes,”² they concluded.

The complete study published in the July issue of the Journal of the American Medical Association.

-Michelle Canales Butcher

References:

1. Pursnani A, Massaro JM, D’Agostino RB, et al. Guideline-based statin eligibility, coronary artery calcification, and cardiovascular events. JAMA. 2015 July [epub ahead of print] doi:10.1001/jama.2015.7515.

2.  Pandya A, SY S, Cho S, et al. Cost-effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease. JAMA. 2015 July [epub ahead of print] doi:10.1001/jama.2015.6822.