Statins for Heart Disease Prevention Could be Recommended for Far Fewer Americans if New Risk Equation is Adopted

June 10, 2024

In a study published in JAMA Internal Medicine, researchers at the University of Pittsburgh, Beth Israel Deaconess Medical Center and University of Michigan examined the potential impact of widespread adoption of the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations, which were released by the American Heart Association in November 2023 to more accurately represent 10-year risk of heart attack or stroke across the current U.S. population.

The previous 10-year risk calculation tool, Pooled Cohort Equations (PCE), is based on now outdated patient data and lacks patient diversity. Unlike PCE, PREVENT equations reflect recent insights into atherosclerotic cardiovascular disease (ASCVD) biology and incorporate current statin use and metabolic and kidney diseases as factors. PREVENT equations have also removed race as a factor to reflect the growing awareness that race is a social construct.

“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” said lead author Timothy Anderson, assistant professor of medicine at Pitt. 

Using PREVENT, the team found that among the study’s cohort of 3,785 adults (ages 40-75), the 10-year risk of developing ASCVD was 4%—half as high as the risk calculated by PCE (8%). The difference was even greater for Black adults (5.1% versus 10.9%) and adults between the ages of 70 and 75 (10.2% versus 22.8%). 

Based on these PREVENT risk calculations, an estimated 4.1 million patients currently taking statins would no longer be recommended to take them.

Clear and careful communication is crucial for these patients and their physicians, said Anderson. “We don’t want people to think they were treated incorrectly in the past. They were treated with the best data we had when PCE was introduced in 2013. The data have changed.”

It is also important to note that everyone’s 10-year risk will inevitably change over time, he added. “If we recommend that a patient—who we now know is at lower risk than we previously thought—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.”

This research was supported by the National Institute on Aging (#K76AG074878).

Read more about the research in JAMA Internal Medicine.

Photo credit: UPMC/John Dillard