New Statin Guidelines Better at Finding Right Patients for Medication

A study finds that new national guidelines can improve the way statins are prescribed to patients at risk for cardiovascular disease (CVD), and produce only a modest increase in the number of patients being given the medication.

The study, published August 25, 2014, in the Journal of the American College of Cardiology, studied over 3,000 subjects to whom the researchers applied both the new and previous guidelines to determine whether patients would start statin therapy. The new guidelines, published in 2013 by the American Heart Association and the American College of Cardiology replaced the 2001 National Cholesterol Education Program (NCEP) Adult Treatment Panel III recommendations.

Coauthors Kevin Johnson, MD, of Yale University School of Medicine, and David A. Dowe, MD, of Atlantic Medical Imaging in Galloway, NJ, said the new guidelines did a better job of discriminating between patients with little or no plaque and those with more plaque. They noted that there has been a great deal of discussion about the new guidelines and whether the new risk equation is accurate and whether there are concerns that too many people will be put on statins.

Among patients with heavy plaque, 92% would be assigned to statin therapy under the new guidelines but only 53% were assigned to statins under the old guidelines. The biggest difference between these 2 results, the researchers said, was the use of low-density lipoprotein (LDL) cholesterol targets under the old guidelines.

The targets “seriously degraded the accuracy of the NCEP guideline for statin assignment,” they concluded. The old guidelines emphasized lowering LDL cholesterol to certain target values; the new guidelines have eliminated that approach.

Overall, 15% more patients would be put on statins under the new guidelines, considerably fewer than some had predicted, the study concludes.