Comparative Accuracy of Statin Eligbility Guidelines From the USPSTF, ACC/AHA for African Americans

HealthDay News – Guidelines differ on recommendations for statin treatment in African-Americans, according to a study published  in JAMA Cardiology to coincide with the annual meeting of the American College of Cardiology, held from March 17 to 19 in Washington, DC.

Ravi V. Shah, MD, from the Massachusetts General Hospital in Boston, and colleagues compared the relative accuracy of the US Preventive Services Task Force (USPSTF) and the American College of Cardiology/American Heart Association (ACC/AHA) recommendations in identifying atherosclerotic cardiovascular disease (ASCVD). 

A total of 2,812 African-American individuals with prevalent ASCVD underwent risk assessment.

The researchers found that the USPSTF and ACC/AHA guidelines identified 55.2% and 69.3% of African-American individuals with a coronary artery calcium (CAC) score greater than 0 (risk difference, 14.1%). There was an association for statin recommendation under both guidelines with a CAC score >0 (odds ratio, 5.1). 

Individuals indicated for statins under both guidelines experienced 9.6 cardiovascular events per 1,000 patient-years, while those indicated only under ACC/AHA guidelines were at low-to-intermediate risk (4.1 events per 1,000 patient-years).

African-Americans not eligible for statins by USPSTF guidelines had a higher ASCVD event rate in the presence of CAC versus without CAC (2.8 versus 0.8 per 1,000 person-years).

“These results support a guideline-based approach to statin recommendation, leveraging targeted imaging (or other surrogate atherosclerotic measures) in African-American individuals to further personalize statin-based prevention programs,” the authors write.

“Clinical application of the USPSTF guidelines to determine statin eligibility focuses treatment on a smaller pool of high-risk individuals at the expense of missing many with vascular calcification and at low to intermediate risk compared with ACC/AHA guidelines and is associated with a similar increased hazard of incident ASCVD compared with ACC/AHA guidelines,” they concluded.

One author disclosed financial ties to General Electric.

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Shah RV, Spahillari A, Mwasongwe S, et al. Subclinical atherosclerosis, statin eligibility, and outcomes in African American individuals: The Jackson Heart Study [published online March 18, 2017] JAMA Cardiol. doi: 10.1001/jamacardio.2017.0944