Newer Cholesterol Guidelines Prove Beneficial and Cost-Effective

The American College of Cardiology and the American Heart Association's release of recommendations for statin treatment in the prevention of cardiovascular disease (CVD) in 2013 have now proven both cost-effective and accurate in identifying CVD risk.

The American College of Cardiology and the American Heart Association’s (ACC/AHA) release of recommendations for statin treatment in the prevention of cardiovascular disease (CVD) in 2013 have now proven both cost-effective and accurate in identifying CVD risk.

According to a study published in JAMA of about 2500 patients, more participants of the study were eligible for statin treatment when using the guidelines set by the ACC/AHA as compared to the previously established guidelines in 2004. The authors emphasized a shift in the treatment approach to CVD, particularly on a transition of focus from traditional treatment measures to absolute cardiovascular risk that was estimated by the 10-year atherosclerotic CVD (ASCVD) score for statin treatment.

Researchers found that the hazard ratio risk of CVD incidents among statin-eligible versus non-eligible participants was higher when applying 2013’s guidelines than when employing the statin eligibility criteria set in 2004.

Essentially, the authors wrote that the application of the ACC/AHA guidelines of 2013 could prevent an estimated 41,000 to 63,000 CVD events over a 10-year period when expanding their findings to a population of 10 million US adults.

“There is no longer any question as to whether to offer treatment with statins for patients for primary prevention, and there should now be fewer questions about how to treat and in whom,” Philip Greenland, MD, and Michael S. Lauer, MD, wrote in an accompanying editorial. “Rather, the next phase of research should be directed at better ways of applying lifestyle and drug treatments to the millions, and possibly billions, worldwide who could potentially benefit from a cost-effective approach to primary prevention of ASCVD.”

In a related study published in JAMA, researchers also found that these same guidelines proved cost-effective for patients. The researchers wrote that the health benefits associated with an ASCVD threshold “of 7.5 percent or higher used in the 2013 ACC-AHA cholesterol guidelines are worth the additional costs required to achieve these health gains, and that a more lenient threshold might also be cost-effective.”

The report found that the 7.5% or higher ASCVD threshold yielded an incremental cost-effectiveness ratio (ICER), of $37,000/quality-adjusted life-year (QALY), which amounts to 48% of patients treated with statins.

Other ASCVD thresholds of 4% or higher and 3% or higher demonstrated ICERs of $81,000/QUALY and $140,000/QUALY, respectively. A shift to these thresholds could lead to the prevention of an additional 125,000 to 160,000 CVD-related events.

The authors used a micro-simulation model that incorporated data from National Health and Nutrition Examination Surveys, clinical trials and meta-analyses for statin-benefits and treatments.