MedicalResearch.com Interview with:
Neha Pagidipati, MD MPH
Duke Clinical Research Institute
Durham, North Carolina
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The 2013 ACC/AHA guidelines for treatment of blood cholesterol to prevent cardiovascular disease created a new paradigm for lipid management and raised numerous ongoing controversies.
In 2016, the US Preventive Services Task Force released recommendations for primary prevention statin therapy which were different in some important ways from the 2013 ACC/AHA guidelines. We aimed to understand the practical difference between these two sets of guidelines in terms of the number of Americans who would be potentially eligible for statin therapy. Using U.S. cross-sectional survey data between 2009 and 2014, we found that, if fully implemented, the USPSTF recommendations would reduce the percentage of US adults age 40-75 who should initiate statin therapy from 24% to 16% as compared to the 2013 ACC/AHA guidelines. Those newly recommended for statin therapy would be in addition to the 21% of US adults already taking lipid-lowering therapy.
Of the approximately 9 million adults who would no longer be recommended to receive statin therapy under the new USPSTF recommendations, over half of them would be younger adults with a high long-term risk of cardiovascular disease (about 1 in 3), and over one quarter would be individuals with diabetes.
MedicalResearch.com: What should readers take away from your report?
Response: When there are multiple sets of guidelines for how to treat patients with statin therapy, it is imperative that clinicians and patients understand the implications of each set of guidelines. We have shown that the USPSTF recommendations would lead to fewer individuals overall being treated with statin therapy to prevent cardiovascular disease, but at the expense of younger individuals and some persons with diabetes who might benefit from such therapy.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We need a set of clinical guidelines that takes into account not only those who are at highest risk for cardiovascular disease, but also those who would benefit most from statin therapy. Future research that can illuminate who will benefit most from statin therapy will be critical in refining the target population for primary prevention statin treatment.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study underscores the importance of having an informed conversation between patients and providers, which both sets of guidelines strongly advocate. Until more definitive recommendations are available, the best we can do is understand and discuss with our patients the pros and cons of statin therapy.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Pagidipati NJ, Navar AM, Mulder H, Sniderman AD, Peterson ED, Pencina MJ. Comparison of Recommended Eligibility for Primary Prevention Statin Therapy Based on the US Preventive Services Task Force Recommendations vs the ACC/AHA Guidelines. JAMA. 2017;317(15):1563-1567. doi:10.1001/jama.2017.3416
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