Study Compares Statin Eligibility of African Americans with USPSTF and ACC/AHA Guidelines

In a recent study, researchers assessed the accuracy of the United States Preventive Services Task Force (USPSTF) guidelines compared with the American College of Cardiology and American Heart Association (ACC/AHA) guidelines for the identification of African American individuals at risk for  atherosclerotic cardiovascular disease (ASCVD). Their findings showed that approximately 1 in 4 African Americans recommended for statin therapy using the ACC/AHA guidelines were not recommended for therapy under the USPSTF guidelines. In addition, the study supported the use of coronary artery calcification (CAC) scoring to personalize recommendations of those who would benefit from statin therapy.
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The prospective, community-based study included 2812 African American individuals 40 to 75 years of age without prevalent ASCVD and not on statin therapy who underwent assessment for ASCVD risk at baseline and at a median 4.5-year follow-up. In addition, 1743 of the participants underwent computed tomography. The main outcomes of the study were CAC score and abdominal aortic calcium score, and recorded incidences of ASCVD, including myocardial infarction, ischemic stroke, or fatal coronary heart disease.

Of the 2812, 1072 (38.1%) participants were found to be eligible for statin therapy under the USPSTF grade B guideline recommendations, compared with 1404 (49.9%) participants under the ACC/AHA guidelines (risk difference, 11.8%; 95% CI, 10.5-13.1; P < .001), meaning that 361 of the 1404 (25.7%) recommended for statin therapy under ACC/AHA guidelines were not recommended for statin therapy under USPSTF guidelines.

Further, “while those who were eligible for statins by both USPSTF and ACC/AHA guidelines had a similar hazard ratio of incident ASCVD compared with noneligible participants, the addition of CAC scoring improved risk stratification above guideline recommendations. Specifically, participants eligible for statin therapy under ACC/AHA guidelines with CAC were at higher risk than those without CAC. Conversely, participants not recommended for statins under USPSTF guidelines who had CAC experienced higher event rates than those without CAC,” the researchers wrote.

“The USPSTF guidelines focus treatment recommendations on 38% of high-risk African American individuals at the expense of not recommending treatment in nearly 25% of African American individuals eligible for statins by ACC/AHA guidelines with vascular calcification and at low to intermediate ASCVD risk.”

—Melissa Weiss

Reference:

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.