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Q) I’m still confused by the change in approach to use of statin therapy for cardiovascular disease. How do I determine which patients need statins?
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in adults in the United States.1 Statins have long been recommended in the management of individuals with ASCVD.
Historically, statin use was guided by an LDL cholesterol (LDL-C) target, per the Adult Treatment Panel (ATP III) guidelines. Therapy was intensified based on whether patients met these targets. Newer guidelines from the American Heart Association/American College of Cardiology (AHA/ACC) base statin therapy not on an LDL-C number but rather on risk stratification that considers several factors.1-3
Continue to: The AHA/ACC guidelines classify statins as...
The AHA/ACC guidelines classify statins as high-, moderate-, or low-intensity.2 They also identify four major groups in whom the benefits of statin therapy for reducing ASCVD risk outweigh the risks of therapy. These include patients with
- Clinical ASCVD (eg, coronary heart disease, stroke, transient ischemic attack, or atherosclerotic peripheral arterial disease)
- Primary elevated LDL-C ≥ 190 mg/dL
- Diabetes (specifically, in those ages 40-75 with an LDL-C of 70-189 mg/dL)
- An estimated 10-year ASCVD risk ≥ 7.5%.2,3 (A risk calculator can be found at www.cvriskcalculator.com).
Recommended statin regimens for patients meeting these criteria are outlined in the Table.
These new guidelines significantly increase the number of adults who are eligible for statin therapy. The number of adults ages 60 to 75 without cardiovascular disease who now qualify for statin therapy has substantially increased (from 30% to 87% in men and from 21% to 54% among women).4 The bulk of this increase is in adults needing primary prevention based on their 10-year cardiovascular risk.4 Evidence as to whether expanded use of statins will improve clinical outcomes is still pending. —AF
Ashley Fort
PA Program at Louisiana State University Health Science Center
1. Gencer B, Auer R, Nanchen D, et al. Expected impact of applying new 2013 AHA/ACC cholesterol guidelines criteria on the recommended lipid target achievement after acute coronary syndromes. Atherosclerosis. 2015; 239(1):118-124.
2. Stone NJ, Robinson JG, Lichtenstein AH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25):2889-2934.
3. Adhyaru B, Jacobson T. New cholesterol guidelines for the management of atherosclerotic cardiovascular disease risk: a comparison of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines with the 2014 National Lipid Association recommendations for patient-centered management of dyslipidemia. Cardiol Clin. 2015;33(15):181-196.
4. Pencina MJ, Navar-Boggan AM, D’Agostino RB Sr, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370(15):1422-1431.
Q) I’m still confused by the change in approach to use of statin therapy for cardiovascular disease. How do I determine which patients need statins?
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in adults in the United States.1 Statins have long been recommended in the management of individuals with ASCVD.
Historically, statin use was guided by an LDL cholesterol (LDL-C) target, per the Adult Treatment Panel (ATP III) guidelines. Therapy was intensified based on whether patients met these targets. Newer guidelines from the American Heart Association/American College of Cardiology (AHA/ACC) base statin therapy not on an LDL-C number but rather on risk stratification that considers several factors.1-3
Continue to: The AHA/ACC guidelines classify statins as...
The AHA/ACC guidelines classify statins as high-, moderate-, or low-intensity.2 They also identify four major groups in whom the benefits of statin therapy for reducing ASCVD risk outweigh the risks of therapy. These include patients with
- Clinical ASCVD (eg, coronary heart disease, stroke, transient ischemic attack, or atherosclerotic peripheral arterial disease)
- Primary elevated LDL-C ≥ 190 mg/dL
- Diabetes (specifically, in those ages 40-75 with an LDL-C of 70-189 mg/dL)
- An estimated 10-year ASCVD risk ≥ 7.5%.2,3 (A risk calculator can be found at www.cvriskcalculator.com).
Recommended statin regimens for patients meeting these criteria are outlined in the Table.
These new guidelines significantly increase the number of adults who are eligible for statin therapy. The number of adults ages 60 to 75 without cardiovascular disease who now qualify for statin therapy has substantially increased (from 30% to 87% in men and from 21% to 54% among women).4 The bulk of this increase is in adults needing primary prevention based on their 10-year cardiovascular risk.4 Evidence as to whether expanded use of statins will improve clinical outcomes is still pending. —AF
Ashley Fort
PA Program at Louisiana State University Health Science Center
Q) I’m still confused by the change in approach to use of statin therapy for cardiovascular disease. How do I determine which patients need statins?
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in adults in the United States.1 Statins have long been recommended in the management of individuals with ASCVD.
Historically, statin use was guided by an LDL cholesterol (LDL-C) target, per the Adult Treatment Panel (ATP III) guidelines. Therapy was intensified based on whether patients met these targets. Newer guidelines from the American Heart Association/American College of Cardiology (AHA/ACC) base statin therapy not on an LDL-C number but rather on risk stratification that considers several factors.1-3
Continue to: The AHA/ACC guidelines classify statins as...
The AHA/ACC guidelines classify statins as high-, moderate-, or low-intensity.2 They also identify four major groups in whom the benefits of statin therapy for reducing ASCVD risk outweigh the risks of therapy. These include patients with
- Clinical ASCVD (eg, coronary heart disease, stroke, transient ischemic attack, or atherosclerotic peripheral arterial disease)
- Primary elevated LDL-C ≥ 190 mg/dL
- Diabetes (specifically, in those ages 40-75 with an LDL-C of 70-189 mg/dL)
- An estimated 10-year ASCVD risk ≥ 7.5%.2,3 (A risk calculator can be found at www.cvriskcalculator.com).
Recommended statin regimens for patients meeting these criteria are outlined in the Table.
These new guidelines significantly increase the number of adults who are eligible for statin therapy. The number of adults ages 60 to 75 without cardiovascular disease who now qualify for statin therapy has substantially increased (from 30% to 87% in men and from 21% to 54% among women).4 The bulk of this increase is in adults needing primary prevention based on their 10-year cardiovascular risk.4 Evidence as to whether expanded use of statins will improve clinical outcomes is still pending. —AF
Ashley Fort
PA Program at Louisiana State University Health Science Center
1. Gencer B, Auer R, Nanchen D, et al. Expected impact of applying new 2013 AHA/ACC cholesterol guidelines criteria on the recommended lipid target achievement after acute coronary syndromes. Atherosclerosis. 2015; 239(1):118-124.
2. Stone NJ, Robinson JG, Lichtenstein AH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25):2889-2934.
3. Adhyaru B, Jacobson T. New cholesterol guidelines for the management of atherosclerotic cardiovascular disease risk: a comparison of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines with the 2014 National Lipid Association recommendations for patient-centered management of dyslipidemia. Cardiol Clin. 2015;33(15):181-196.
4. Pencina MJ, Navar-Boggan AM, D’Agostino RB Sr, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370(15):1422-1431.
1. Gencer B, Auer R, Nanchen D, et al. Expected impact of applying new 2013 AHA/ACC cholesterol guidelines criteria on the recommended lipid target achievement after acute coronary syndromes. Atherosclerosis. 2015; 239(1):118-124.
2. Stone NJ, Robinson JG, Lichtenstein AH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25):2889-2934.
3. Adhyaru B, Jacobson T. New cholesterol guidelines for the management of atherosclerotic cardiovascular disease risk: a comparison of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines with the 2014 National Lipid Association recommendations for patient-centered management of dyslipidemia. Cardiol Clin. 2015;33(15):181-196.
4. Pencina MJ, Navar-Boggan AM, D’Agostino RB Sr, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370(15):1422-1431.
