CDC expert questions statin use for more Americans

June 24, 2014

Last November, the American Heart Association (AHA) and the American College of Cardiology (ACC) recommended statin therapy for approximately 33 million more Americans who don’t have cardiovascular disease (CVD), but have an estimated 10-year CV risk of 7.5% or higher.

Last November, the American Heart Association (AHA) and the American College of Cardiology (ACC) recommended statin therapy for approximately 33 million more Americans who don’t have cardiovascular disease (CVD), but have an estimated 10-year CV risk of 7.5% or higher.

However, an expert from the Centers for Disease Control and Prevention recently said the new guidelines would provide a limited benefit for additional cost, especially in low-risk individuals who would be newly eligible for statins, among them some diabetes patients.

According to the new AHA/ACC guidelines, there are four major groups of adults who could benefit from moderate- to high-intensity statin therapy. They are patients who are 75 years and younger with clinical CVD, patients with low-density lipoprotein (LDL) cholesterol of 190 mg/dL or more, patients with type 1 and 2 diabetes who are 40 to 75 years old, and patients who are 40 to 75 years with an estimated 10-year CVD risk of 7.5% or more and whose LDL cholesterol is between 70 mg/dL and 189 mg/dL.

During a recent presentation at the American Diabetes Association’s 74th Scientific Sessions in San Francisco, Xiaohui Zhuo, PhD, division of diabetes translation at the CDC, said intensive statin use was not cost-effective in patients with diabetes if their atherosclerotic CVD risk was 7.5% to 10%.

Zhuo said moderate statin use was cost-effective only if atherosclerotic CVD risk was >10% in adults without diabetes. However, it was not cost-effective otherwise, particularly in patients with prediabetes.

“The new ACC/AHA’s cholesterol guidelines are a paradigm shift with respect to CVD primary prevention,” Zhuo said. “These will have large implications for diabetes care, particularly for CVD primary prevention care.”

 

Zhuo and other CDC researchers used a simulation model to assess the lifetime atherosclerotic CVD and diabetes outcomes, costs, and cost-effectiveness of the AHA/ACC recommendations.

Their research indicated the new guidelines reduced lifetime atherosclerotic CVD incidence, but increased diabetes risk among adults without diabetes.