New Guidelines Increase Statin Use Only Moderately

Statin guidelines released jointly by the American Heart Association and the American College of Cardiology more accurately identify patients with heavy arterial plaque buildup for therapy.

Only 15% more patients would take statins under treatment guidelines released in late 2013 by the American Heart Association and the American College of Cardiology, Yale University researchers state.

The study found that the new guidelines were better than the old standards at discriminating between patients with little or no plaque accumulation and those with more plaque, the research found. Under the new guidelines, 92% of participants with heavy plaque accumulation would be put on statin therapy, whereas the older guidelines would only recommend therapy to 53% of those participants.

The findings were published online on August 25, 2014, in the Journal of the American College of Cardiology.

Lead author Kevin M. Johnson, MD, associate professor of diagnostic radiology at Yale School of Medicine, and co-author David A. Dowe, MD, of Atlantic Medical Imaging, studied computed tomography angiography scans from 3076 participants to assess the burden of coronary atherosclerosis. They then assessed the scans to determine treatment course under the Guidelines on the Assessment of Cardiovascular Risk (GACR), which are the newer guidelines, and the National Cholesterol Education Program (NCEP) Adult Treatment Panel III recommendations, which were approved in 2001.

“There has been a great deal of discussion about the new guidelines,” Dr. Johnson said in a press release. “People worry whether the new risk equation is accurate. They are concerned that too many people will be put on statins.”

The researchers found that in addition to better distinguishing between participants with little to no plaque buildup and those with heavy arterial plaque, the biggest change to the new guidelines was the elimination of low-density lipoprotein (LDL) targets. According to researchers, the targets established under NCEP compromised statin assignment.

“The old guidelines emphasized lowering LDL cholesterol to certain target values, but the new guidelines have done away with that approach,” Dr. Johnson said. “Many doctors are reluctant to give up targets.”