A new study conducted by researchers at the University of Pittsburgh, Beth Israel Deaconess Medical Center, and the University of Michigan suggests that if national guidelines adopt a new risk equation, approximately 40% fewer Americans would meet the criteria for cholesterol-lowering statins to prevent heart disease.

Published in JAMA Internal Medicine, the study examines the potential impact of widespread adoption of the PREVENT equations, which were released by the American Heart Association in November 2023. These equations aim to update physicians' go-to calculators for assessing patients' 10-year risk of heart attack or stroke.

The researchers used nationally representative data from 3,785 adults between the ages of 40 and 75, who participated in the National Health and Nutrition Examination Survey from January 2017 to March 2020. By using the PREVENT equations, the team estimated the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) and compared the results to the risk estimated using the previous tool known as the Pooled Cohort Equations (PCE).

The PREVENT equations were developed to provide a more accurate representation of risk across the current U.S. population. The previous PCE equations were based on outdated patient data lacking diversity. The newer equations also incorporate current statin use, metabolic and kidney diseases, while removing race from the calculation, acknowledging that race is a social construct.

The study found that, at a population level, the number of adults recommended for statin therapy would decrease from 45.4 million to 28.3 million if the PREVENT equations were adopted. Interestingly, the study also revealed that most people who should be recommended to take statins are not currently taking them.

Dr. Timothy Anderson, the lead author of the study and a primary care physician at UPMC, emphasizes that this revised risk equation presents an opportunity to refocus efforts and resources on the populations at the highest risk. It is crucial to communicate clearly and carefully with the estimated 4.1 million patients who would no longer be recommended to take statins based on the PREVENT equations, ensuring that they understand this change is due to evolving data and improved understanding of cardiovascular disease risks.

Dr. Anderson also points out the importance of recognizing that individuals' risk levels can change over time. Lower-risk patients may still face an increased risk as they age, highlighting the need for ongoing assessment and adjustments in treatment plans.

While the implementation of the new risk equation may provide a more accurate assessment of an individual's risk for heart disease, it is essential for healthcare providers to carefully evaluate and communicate these changes to patients while considering their unique circumstances. By focusing resources on those at the highest risk, medical interventions can be more targeted and effective in preventing heart disease.