ACC/AHA guidelines are superior to ATP III at identifying CVD risk

Since the American College of Cardiology (ACC) and American Heart Association (AHA) released guidelines for managing blood cholesterol in 2013, millions more people have become eligible to receive statin treatment. However, some physicians have criticized the changes and not followed them. A community-based cohort study published online in JAMA on July 14 may help ease their concerns.

Researchers found that the ACC/AHA guidelines were better at identifying an increased risk of cardiovascular disease compared with the National Cholesterol Education Program's Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) guidelines, which were last updated in 2004.

By adopting the guidelines, an estimated 41,000 to 63,000 cardiovascular events could be prevented during a 10-year period. They based the estimates on the approximately 10 million adults in the U.S. who are newly eligible for statins under the ACC/AHA guidelines.

Whereas the ATP III guidelines focused on low-density lipoprotein cholesterol to determine who should receive statins, the ACC/AHA guidelines apply a 10-year atherosclerotic cardiovascular disease risk score.

Still, lead researcher Udo Hoffmann, MD, MPH, of Massachusetts General Hospital and Harvard Medical School, said only approximately 30 percent of patients who are prescribed statins remain on them for at least two years.

“I think this will put some doubts to rest and will perhaps lead to a broader acceptance of these relatively new guidelines,” Hoffmann told Cardiovascular Business. “But the next challenge is for the patients who are being prescribed statins, are they going to take statins long-term? There is a lot of work to do in order to make that happen.”

The researchers examined 2,435 people who were the offspring and third generation cohorts of the Framingham Heart Study. They underwent CT scans for coronary artery calcification between 2002 and 2005. The mean age was 51.3, and 56 percent of participants were women.

Of the participants, 39 percent were eligible for statins based on the ACC/AHA criteria compared with 14 percent based on the ATP III criteria. During a median follow up of 9.4 years, there were 74 cardiovascular disease events: 40 nonfatal MIs, 31 nonfatal ischemic strokes and three fatal coronary heart disease events.

Researchers found the risk of having cardiovascular disease among statin-eligible vs. noneligible people was significantly higher when they applied the ACC/AHA guidelines compared with the ATP III guidelines. The results were consistent across subgroups.

“I think there was some uncertainty around these guidelines,” Hoffmann said. “But I think there’s more and more evidence now that these guidelines are good for the patient. I would hope that physicians are taking them as their guide to prescribe statins.”