Statin eligibility, coronary artery calcium, and subsequent cardiovascular events according to the 2016 United States Preventive Services Task Force (USPSTF) statin guidelines

MESA (Multi-Ethnic Study of Atherosclerosis)

Michael D. Miedema, Zeina A. Dardari, Sina Kianoush, Salim S. Virani, Joseph Yeboah, Thomas Knickelbine, Veit Sandfort, Carlos J. Rodriuez, Khurram Nasir, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Background--The potential impact of the 2016 United States Preventive Services Task Force (USPSTF) guidelines on statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) warrants further analysis. Methods and Results--We studied participants from MESA (Multi-Ethnic Study of Atherosclerosis) aged 40 to 75 years and not on statins. We compared statin eligibility at baseline (2000-2002) and over follow-up between USPSTF and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Coronary artery calcium (CAC) was measured at baseline. Absolute ASCVD event rates were calculated according to eligibility categories for each guideline. Among 4962 MESA participants (aged 59.3±8.8 years, 47.2% female), compared with ACC/AHA guidelines, baseline statin eligibility by USPSTF was significantly lower (34.4% versus 49.1%) and increased less over time (39.1% versus 59.1%) at examination 5 [years 2010-2012]). Compared with ACC/AHA, participants eligible by USPSTF were less likely to have zero CAC at baseline (36.6% versus 41.2%) and had higher rates of hard ASCVD events per 1000 person-years (11.6 [95% confidence interval, 10.2-13.3] versus 10.0 [8.9-11.3]). The hard ASCVD event rate in those eligible by ACC/AHA but not USPSTF was 6.5 (4.9-8.5) events per 1000 person-years, with the rate varying significantly according to baseline CAC (4.2 [2.7-6.7] events in those with CAC=0, 12.8 [8.3-19.9] events in those with CAC > 100). Conclusions--In MESA, compared with ACC/AHA, the USPSTF statin guidelines resulted in a 15% absolute decrease in eligibility. Participants with discordant eligibility had ASCVD rates that varied significantly according to baseline CAC, suggesting CAC could aid clinical decision making for statins in these individuals.

Original languageEnglish (US)
Article numbere008920
JournalJournal of the American Heart Association
Volume7
Issue number12
DOIs
StatePublished - Jun 1 2018

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Advisory Committees
Atherosclerosis
Coronary Vessels
American Heart Association
Guidelines
Calcium
Cardiology
Cardiovascular Diseases
Primary Prevention
Confidence Intervals

Keywords

  • Guideline
  • Primary prevention
  • Statin therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Statin eligibility, coronary artery calcium, and subsequent cardiovascular events according to the 2016 United States Preventive Services Task Force (USPSTF) statin guidelines : MESA (Multi-Ethnic Study of Atherosclerosis). / Miedema, Michael D.; Dardari, Zeina A.; Kianoush, Sina; Virani, Salim S.; Yeboah, Joseph; Knickelbine, Thomas; Sandfort, Veit; Rodriuez, Carlos J.; Nasir, Khurram; Blaha, Michael.

In: Journal of the American Heart Association, Vol. 7, No. 12, e008920, 01.06.2018.

Research output: Contribution to journalArticle

Miedema, Michael D. ; Dardari, Zeina A. ; Kianoush, Sina ; Virani, Salim S. ; Yeboah, Joseph ; Knickelbine, Thomas ; Sandfort, Veit ; Rodriuez, Carlos J. ; Nasir, Khurram ; Blaha, Michael. / Statin eligibility, coronary artery calcium, and subsequent cardiovascular events according to the 2016 United States Preventive Services Task Force (USPSTF) statin guidelines : MESA (Multi-Ethnic Study of Atherosclerosis). In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 12.
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title = "Statin eligibility, coronary artery calcium, and subsequent cardiovascular events according to the 2016 United States Preventive Services Task Force (USPSTF) statin guidelines: MESA (Multi-Ethnic Study of Atherosclerosis)",
abstract = "Background--The potential impact of the 2016 United States Preventive Services Task Force (USPSTF) guidelines on statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) warrants further analysis. Methods and Results--We studied participants from MESA (Multi-Ethnic Study of Atherosclerosis) aged 40 to 75 years and not on statins. We compared statin eligibility at baseline (2000-2002) and over follow-up between USPSTF and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Coronary artery calcium (CAC) was measured at baseline. Absolute ASCVD event rates were calculated according to eligibility categories for each guideline. Among 4962 MESA participants (aged 59.3±8.8 years, 47.2{\%} female), compared with ACC/AHA guidelines, baseline statin eligibility by USPSTF was significantly lower (34.4{\%} versus 49.1{\%}) and increased less over time (39.1{\%} versus 59.1{\%}) at examination 5 [years 2010-2012]). Compared with ACC/AHA, participants eligible by USPSTF were less likely to have zero CAC at baseline (36.6{\%} versus 41.2{\%}) and had higher rates of hard ASCVD events per 1000 person-years (11.6 [95{\%} confidence interval, 10.2-13.3] versus 10.0 [8.9-11.3]). The hard ASCVD event rate in those eligible by ACC/AHA but not USPSTF was 6.5 (4.9-8.5) events per 1000 person-years, with the rate varying significantly according to baseline CAC (4.2 [2.7-6.7] events in those with CAC=0, 12.8 [8.3-19.9] events in those with CAC > 100). Conclusions--In MESA, compared with ACC/AHA, the USPSTF statin guidelines resulted in a 15{\%} absolute decrease in eligibility. Participants with discordant eligibility had ASCVD rates that varied significantly according to baseline CAC, suggesting CAC could aid clinical decision making for statins in these individuals.",
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T1 - Statin eligibility, coronary artery calcium, and subsequent cardiovascular events according to the 2016 United States Preventive Services Task Force (USPSTF) statin guidelines

T2 - MESA (Multi-Ethnic Study of Atherosclerosis)

AU - Miedema, Michael D.

AU - Dardari, Zeina A.

AU - Kianoush, Sina

AU - Virani, Salim S.

AU - Yeboah, Joseph

AU - Knickelbine, Thomas

AU - Sandfort, Veit

AU - Rodriuez, Carlos J.

AU - Nasir, Khurram

AU - Blaha, Michael

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background--The potential impact of the 2016 United States Preventive Services Task Force (USPSTF) guidelines on statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) warrants further analysis. Methods and Results--We studied participants from MESA (Multi-Ethnic Study of Atherosclerosis) aged 40 to 75 years and not on statins. We compared statin eligibility at baseline (2000-2002) and over follow-up between USPSTF and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Coronary artery calcium (CAC) was measured at baseline. Absolute ASCVD event rates were calculated according to eligibility categories for each guideline. Among 4962 MESA participants (aged 59.3±8.8 years, 47.2% female), compared with ACC/AHA guidelines, baseline statin eligibility by USPSTF was significantly lower (34.4% versus 49.1%) and increased less over time (39.1% versus 59.1%) at examination 5 [years 2010-2012]). Compared with ACC/AHA, participants eligible by USPSTF were less likely to have zero CAC at baseline (36.6% versus 41.2%) and had higher rates of hard ASCVD events per 1000 person-years (11.6 [95% confidence interval, 10.2-13.3] versus 10.0 [8.9-11.3]). The hard ASCVD event rate in those eligible by ACC/AHA but not USPSTF was 6.5 (4.9-8.5) events per 1000 person-years, with the rate varying significantly according to baseline CAC (4.2 [2.7-6.7] events in those with CAC=0, 12.8 [8.3-19.9] events in those with CAC > 100). Conclusions--In MESA, compared with ACC/AHA, the USPSTF statin guidelines resulted in a 15% absolute decrease in eligibility. Participants with discordant eligibility had ASCVD rates that varied significantly according to baseline CAC, suggesting CAC could aid clinical decision making for statins in these individuals.

AB - Background--The potential impact of the 2016 United States Preventive Services Task Force (USPSTF) guidelines on statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) warrants further analysis. Methods and Results--We studied participants from MESA (Multi-Ethnic Study of Atherosclerosis) aged 40 to 75 years and not on statins. We compared statin eligibility at baseline (2000-2002) and over follow-up between USPSTF and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Coronary artery calcium (CAC) was measured at baseline. Absolute ASCVD event rates were calculated according to eligibility categories for each guideline. Among 4962 MESA participants (aged 59.3±8.8 years, 47.2% female), compared with ACC/AHA guidelines, baseline statin eligibility by USPSTF was significantly lower (34.4% versus 49.1%) and increased less over time (39.1% versus 59.1%) at examination 5 [years 2010-2012]). Compared with ACC/AHA, participants eligible by USPSTF were less likely to have zero CAC at baseline (36.6% versus 41.2%) and had higher rates of hard ASCVD events per 1000 person-years (11.6 [95% confidence interval, 10.2-13.3] versus 10.0 [8.9-11.3]). The hard ASCVD event rate in those eligible by ACC/AHA but not USPSTF was 6.5 (4.9-8.5) events per 1000 person-years, with the rate varying significantly according to baseline CAC (4.2 [2.7-6.7] events in those with CAC=0, 12.8 [8.3-19.9] events in those with CAC > 100). Conclusions--In MESA, compared with ACC/AHA, the USPSTF statin guidelines resulted in a 15% absolute decrease in eligibility. Participants with discordant eligibility had ASCVD rates that varied significantly according to baseline CAC, suggesting CAC could aid clinical decision making for statins in these individuals.

KW - Guideline

KW - Primary prevention

KW - Statin therapy

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U2 - 10.1161/JAHA.118.008920

DO - 10.1161/JAHA.118.008920

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