Studies show superiority of ACC/AHA guidelines for managing blood cholesterol

Two studies published this month in JAMA clarified and proved the cost-effectiveness of statins and the validity of controversial guidelines for managing blood cholesterol. Whether the results will lead to more people receiving treatment remains to be seen, but the evidence indicated the American College of Cardiology/American Heart Association (ACC/AHA) guidelines should be followed more closely.

In the first study, researchers found the ACC/AHA guidelines were better at identifying an increased risk of cardiovascular disease compared with the old guidelines that were last updated 11 years ago. In the second study, researchers built a computer simulation model that supported the atherosclerotic cardiovascular disease (ASCVD) risk score treatment threshold used in the ACC/AHA guidelines.

“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 Greenwald, MD, of Northwestern University’s school of medicine in Chicago, and Michael S. Lauer, MD, of the National Heart, Lung and Blood Institute, 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.”

Since the guidelines were introduced in 2013, some questioned the recommendation to use the ASCVD risk score to determine who should take statins. Previously, guidelines focused on low-density lipoprotein cholesterol. However, the research released on July 14 estimated that 41,000 to 63,000 cardiovascular events could be prevented during a 10-year period by adopting the new guidelines instead of the old ones.

There were also criticisms regarding the ACC/AHA guidelines committee members choosing to use a 10-year ASCVD risk score of 7.5 percent or higher as the cutoff point for statin use. Still, lead researcher Ankur Pandya, PhD, of the Harvard School of Public Health, and colleagues showed that implementing a 10-year ASCVD risk as low as 3.0 percent could be considered cost-effective.

By adopting the guidelines, fewer adverse cardiovascular events would arise and the benefits would more than offset the costs.

“I think there was some uncertainty around these guidelines,” researcher Udo Hoffmann, MD, MPH, of Massachusetts General Hospital and Harvard Medical School, told Cardiovascular Business. “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.”

-Tim Casey
Executive Editor