Remember all the controversy over the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Guidelines related to the eligibility recommendations for statins? The controversy still continues and focuses around identifying and recommending statins for more people than those at high-risk. It is important to remember that guidelines and recommendations are to be used along with the practitioner’s clinical judgment and treatment is based on individual patient’s unique needs and circumstances.
So what were the ACC/AHA 2013 guideline recommendations? Previously, cholesterol management was focused on LDL-C and/or HDL-C targets for treatment guidance. The 2013 recommendations focus instead on the intensity of statin therapy to reduce the risk of atherosclerotic cardiovascular disease (ASCVD) in people who would likely benefit (primary prevention). The new guidelines advocate to NOT use a one-treatment-fits-all approach, but rather a patient-centered approach. Consideration should be given to:
- Potential for ASCVD risk reduction benefit
- Adverse effects
- Drug-to-drug interactions
- Patient preferences
(Stone et al., 2013)
A lot of attention was also focused around the new AHA/ACC Cardiovascular (CV) Risk Calculator that estimates the 10-year ASCVD risk in both white and black men and women who do NOT have clinical ASCVD. Much of this controversy was related to over identifying people who are at-risk.
With that being said, where are we today? Recent studies in the Journal of the American Medical Association (07/14/2015) compare the higher use of statins for both primary and secondary prevention as well as cost-effectiveness of the increase in statin use. The evidence shows that the use of statins for primary prevention is both effective and cost-effective, even for the people who are at a low risk level. It is important to remember that lifestyle modifications are still essential even with the use of statins.
The studies compare populations using both the 2004 Adult Treatment Panel (ATP) 3 and the new 2013 ACC/AHA guidelines. The research finds patients in the at-risk groups with the ACC/AHA guidelines were nearly seven times more likely to be at risk for cardiovascular disease (CVD) that those patients not eligible for statins. One study with 2,435 patients identifies 80 percent of patients as at-risk using the 2013 guidelines vs. 37 percent using the 2004 guidelines.
The other study looks at the cost-effectiveness of using statins for both primary and secondary prevention. One significant factor is that most of the statins are now available as generics and the price is considerably less. The study not only looked at cost but other factors including loss of quality of life associated with taking statins. Overall, the study validates the cost-effectiveness but also points out that for some lower risk patients who have aversions to taking statins may benefit with lifestyle modifications as the best choice at that time.
It is important as leaders and clinicians to stay abreast of guideline changes and communicate with the practitioner to know what the current treatment plan is for that particular patient. Home health can provide a lot of education on cholesterol management, especially with disease process, what the blood levels mean, lifestyle modifications, statin use and side effects, adherence, and the risk for a heart attack or a stroke.
September is Cholesterol Education Month – bring that personal messaging home for each patient, your family, and yourself!
Learn more about cholesterol management and available tools and resources in the Cardiovascular Health Part 2: Cholesterol management & Smoking cessation Best Practice Intervention Package (BPIP).