Specificity of Statin Therapy Improved With Disease-Guided Approach

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Statin treatment specificity may be improved with the use of a disease-guided approach.
Statin treatment specificity may be improved with the use of a disease-guided approach.

(HealthDay News) — A disease-guided approach to statin eligibility can improve treatment specificity, according to a study published in the Journal of the American College of Cardiology.

Martin Bødtker Mortensen, MD, PhD, from Aarhus University Hospital in Denmark, and colleagues personalized American College of Cardiology (ACC)/American Heart Association (AHA) risk-based statin eligibility criteria. Among 5805 BioImage participants, down-classification from statin eligible to ineligible occurred for those with ≥7.5% 10-year atherosclerotic cardiovascular disease risk if imaging revealed no coronary artery calcium (CAC) or carotid plaque burden (cPB).

The researchers found that 86% of participants qualified for ACC/AHA risk-based statin therapy, with 96% sensitivity and 15% specificity. CAC and cPB scores of 0 were seen in 32% and 23%, respectively, and correlated with low event rates. Specificity for coronary heart disease events improved 22% with CAC-guided reclassification (P<.0001), with no significant loss in sensitivity, for a binary net reclassification index (NRI) of 0.20 (P<.0001). Specificity improved 16% with cPB-guided reclassification (P<.0001), with minor loss of sensitivity (7%), for a NRI of 0.09 (P=.001). For cardiovascular disease events the NRI was 0.14 and 0.06 for CAC-guided and cPB-guided, respectively.

"Withholding statins in individuals without CAC or carotid plaque could spare a significant proportion of elderly people from taking a pill that would benefit only a few," the researchers wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical industry; the BioImage Study was designed by the High-Risk Plaque Initiative, which was funded by pharmaceutical companies.

Reference

  1. Mortensen MB, Fuster V, Muntendam P, et al. A simple disease-guided approach to personalize ACC/AHA-recommended statin allocation in elderly people: the BioImage Study. J Am Coll Cardiol. 2016;68(9):881-891. doi:10.1016/j.jacc.2016.05.084.
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