PREVENT Equation Could Disrupt Prescription of Statins in Primary Prevention

Results of a recent analysis is sounding the alarm on a potential, unforeseen consequence that could arise as a result of using the American Heart Association’s new PREVENT risk: a degradation of the role for statins in primary prevention.

The study, which included data from more than 3700 adults who participated in the National Health and Nutrition Examination Survey, concluded use of the PREVENT equation was associated with fewer adult patients being eligible for primary prevention statin therapy than use of older Pooled Cohort Equations (PCE).¹

“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” said lead investigator Timothy Anderson, MD, MAS, a primary care physician at the University of Pittsburgh Medical Center and health services researcher and assistant professor of medicine at University of Pittsburgh.²

Introduced by the AHA at their 2023 annual meeting, the Predicting Risk of Cardiovascular Disease Events (PREVENT) risk calculator was launched to better incorporate cardiovascular-kidney-metabolic syndrome in cardiovascular disease risk prevention. Upon launch in 2023, the AHA highlighted the new risk equation was designed to assess cardiovascular risk in people from ages 30 to 79 years and to predict risk for heart attack, stroke, and/or heart failure over the next 10 years and 30 years. A key difference from the PCE established in 2013 is the incorporation of kidney function and HbA1c into the risk equation.^1,3

In the current study, Anderson sought to assess how use of the PREVENT equation might influence 10-year ASCVD risk scores as well as the recommendation for primary prevention statin therapy. With this in mind, investigators designed their study with 10-year ASCVD risk and eligibility for primary prevention statin therapy based on PREVENT and PCE equations as the primary outcomes of interest.¹

For the purpose of analysis, investigators used data from adults aged 40 to 75 years from within the National Health and Nutrition Examination Survey from 2017 through March 2020. In total, the weighted sample identified for inclusion in the analysis was 3785 adults.¹

This cohort had a mean age of 55.7 (SD, 9.7) years, 52.5% were women, and 66.7% identified as White individuals. Of those included in the sample, 15.7% had diabetes, 15.5% reported current smoking, and 20.7% reported statin use.¹

Upon analysis, investigators found this cohort had an estimated 10-year ASCVD risk of 8.0% (95% CI, 7.6% to 8.4%) using the PCEs and 4.3% (95% CI, 4.1% to 4.5%) using the PREVENT equations. Further analysis demonstrated the mean estimated 10-year ASCVD risk was lower using the PREVENT equations across all age, sex, and racial subgroups relative to use of the PCEs. Investigators noted the largest difference for Black adults (10.9% [95% CI, 10.1% to 11.7%] vs 5.1% [95% CI, 4.7% to 5.4%]) and individuals aged 70 to 75 years (22.8% [95% CI, 21.6% to 24.1%] vs 10.2% [95% CI, 9.6% to 10.8%]).¹

Additionally, investigators found the use of the PREVENT equations rather than PCEs could reduce the number of adults meeting criteria for primary prevention statin therapy from 45.4 million (95% CI, 40.3 to 50.4) to 28.3 million (95% CI, 25.2 to 31.4). Further expanding on this finding, investigators pointed out discontinuing use of PCEs in favor of PREVENT equations could result in 17.3 million (95% CI, 14.8 to 19.7) adults recommended statins to no longer be recommended statins, including 4.1 million (95% CI, 2.8 to 5.5) adults who are currently taking statins. With use PREVENT equations, investigators found 44.1% (95% CI, 38.6%-49.5%) of adults considered eligible for primary prevention statin therapy reported currently taking statins, which investigators underlined equated to 15.8 million (95% CI, 13.4 million-18.2 million) individuals eligible for primary prevention statins who reported not taking statins.¹

“For a patient who we now know is at lower risk than we previously thought, if we recommend they stop taking statins, they still could be back to a higher risk five years down the road, for the simple reason that everybody’s risk goes up as we get older,” Anderson added.²

References:

1. ^{Anderson TS, Wilson LM, Sussman JB. Atherosclerotic Cardiovascular Disease Risk Estimates Using the Predicting Risk of Cardiovascular Disease Events Equations. JAMA Intern Med. Published online June 10, 2024. doi:10.1001/jamainternmed.2024.1302}
2. ^{UPMC. Statins for heart disease prevention recommended for fewer Americans. UPMC. June 10, 2024. Accessed June 11, 2024. https://www.upmc.com/media/news/061024-statins-for-heart.}
3. ^{American Heart Association. Leading cardiologists reveal New Heart Disease Risk Calculator. American Heart Association. November 10, 2023. Accessed June 11, 2024. https://newsroom.heart.org/news/leading-cardiologists-reveal-new-heart-disease-risk-calculator.}