Intensity of statin therapy for primary prevention has increased since the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines; however, the change in the percentage of patients appropriately placed on statin therapy has been insignificant, according to a study published in The American Journal of Cardiology.

A team of researchers from Illinois and California conducted a retrospective primary and sensitivity analysis to determine the effects of the 2013 ACC/AHA guidelines on statin use for primary prevention in patients with first-time acute coronary syndrome (ACS).

The 10-year predicted atherosclerotic cardiovascular disease (10yASCVD) risk score was calculated in 1265 patients aged 40 to 75 years (mean age, 58.29; 63.64% men) who presented with ACS and no previous ASCVD. The 10yASCVD calculation included an ambulatory systolic blood pressure (SBP); a linear regression model was used to predict SBP for patients without known ambulatory SBP.

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Outcomes measured included statin status and statin intensity (high, medium, or low), which was subcategorized by ACS event type and date of left heart catheterization.

The investigators defined agreement between 10yASCVD and statin status as 10yASCVD ≥7.5% on statin therapy and 10yASCVD <5% not on statins (not including patients with diabetes).

Primary analysis resulted in 41% of patients with 10yASCVD ≥7.5% on statin therapy prior to the 2013 guideline compared with 42.9% after the 2013 guideline publication; 33.6% of patients with predicted SBP with 10yASCVD ≥7.5% were on statins before 2013 compared with 35.9% after the guideline release.

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In addition, 79.3% of patients with 10yASCVD ≥7.5% who were on statin therapy before the 2013 guidelines were administered high- or medium-intensity statins compared with 89.6% following the guideline release. Similar results were reported in the sensitivity analysis.

“In summary, retrospective calculation of 10yASCVD in patients with a first ACS event showed a significant number of ACS patients would have qualified for statin therapy per 2013 ACC/AHA guidelines before their event but had not been initiated on one,” the investigators wrote.

“Since the initiation of statins in primary prevention depends on analyzing both initial ASCVD risk and the potential for overall benefit based on the evidence, our data may help clinicians and their patients understand the potential value of guideline adherence,” the authors concluded.



Bavishi A, Howard T, Kim JP, et al. Treatment gap in primary prevention patients presenting with acute coronary syndrome [published online November 7, 2018]. Am J Cardiol. doi:10.1016/j.amjcard.2018.10.034