Author(s): Pencina MJ, NavarBoggan AM, D Agostino RB Sr
The ACC-AHA new guidelines for management of cholesterol were released in November of 2013. The new guidelines recommended treatment of patients with LDL cholesterol of 70 mg per deciliter if they have either diabetes or a ten-year risk of cardiovascular disease of 7.5% or more. In addition, the new guidelines expanded the treatment recommendations for statin therapy to all patients with known cardiovascular disease regardless of the LDL cholesterol level. The authors utilized National Health and Nutrition Examination Surveys (NHANES) to estimate the number of persons in the United States for whom statin therapy would be recommended on the basis of the new guidelines as compared with the previous guidelines. NHANES data from 2005 to 2010 was used. Data provided a risk-factor profile of persons for whom statin therapy would be recommended under the new ACC-AHA guidelines as compared with the Third Adult Treatment panel (ATP-III) of the National Cholesterol Education Program. Data was then extrapolated to a population of 115.4 million U.S. adults between the ages of 40 and 75 years. Compared with ATP-III guidelines, the new guidelines would increase the number of U.S. adults receiving or eligible for statin therapy from 43.2 million (37.5%) to 56.0 million (48.6%). 10.4 million of this 12.8 million increase would occur among adults without cardiovascular disease. Among adults between the ages of 60 and 75 years without cardiovascular disease not receiving statin therapy, the percentage that would be eligible for such therapy would increase from 30.4% to 87.4% among men and from 21.2% to 53.6% among women. This effect is driven largely by the increased number of adults who would be classified solely on the basis of their estimated ten-year risk of a cardiovascular event. Those eligible for statin therapy would include more men than women and persons with a higher blood pressure but a markedly lower level of LDL cholesterol.