Current clinical guidelines recommend the use of a global risk assessment tool, such
as those pioneered by the Framingham Heart Study, to determine eligibility for statin
therapy in patients with absolute risk levels greater than a certain threshold. In
support of this approach, several randomized trials have reported that patients with
high absolute risk clearly benefit from statin therapy. Therefore, the guideline recommendations
would seem intuitive and effective, albeit on the core assumption that the mortality
and morbidity benefits associated with statin therapy would be greatest in those with
high predicted absolute risk. However, if this assumption is incorrect, using predicted
absolute risk to guide statin therapy could easily result in underuse in some groups
and overuse in others. Herein, the authors question the utility of global risk assessment
strategies based on the Framingham risk score for guiding statin therapy in light
of current data that have become available from more recent and robust prospective
randomized clinical trials since the publication of the National Cholesterol Education
Program Adult Treatment Panel III guidelines. Moreover, the Adult Treatment Panel
III guidelines do not support treatment of some patients who may benefit from statin
therapy. In conclusion, the authors propose an alternative approach for incorporating
more recent randomized trial data into future statin allocation algorithms and treatment
guidelines.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial.Lancet. 2002; 360: 7-22
- Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.Lancet. 2005; 366: 1267-1278
- Intensive versus moderate lipid lowering with statins after acute coronary syndromes.N Engl J Med. 2004; 350: 1495-1504
- Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.Circulation. 2004; 110: 227-239
- Intensive lipid lowering with atorvastatin in patients with stable coronary disease.N Engl J Med. 2005; 352: 1425-1435
- Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.Lancet. 2003; 361: 1149-1158
- Established and emerging plasma biomarkers in the prediction of first atherothrombotic events.Circulation. 2004; 109: IV6-IV19
- Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform?.J Am Coll Cardiol. 2003; 41: 1475-1479
- The distribution of 10-year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III.J Am Coll Cardiol. 2004; 43: 1791-1796
- Further improvements in CHD risk prediction for women.JAMA. 2007; 297: 641-643
- Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age.Circulation. 2006; 113: 791-798
- Framingham risk score and prediction of lifetime risk for coronary heart disease.Am J Cardiol. 2004; 94: 20-24
- Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: the coronary artery risk development in young adults study and multi-ethnic study of atherosclerosis.Circulation. 2009; 119: 382-389
- Risk factor burden in middle age and lifetime risks for cardiovascular and non-cardiovascular death (Chicago Heart Association Detection Project in Industry).Am J Cardiol. 2007; 99: 535-540
- Family history of premature coronary heart disease and coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA).Circulation. 2007; 116: 619-626
- Usefulness of cardiovascular family history data for population-based preventive medicine and medical research (the Health Family Tree Study and the NHLBI Family Heart Study).Am J Cardiol. 2001; 87: 129-135
- Family history is a coronary heart disease risk factor in the Second Northwick Park Heart Study.Ann Hum Genet. 2003; 67: 97-106
- Screening for cardiovascular risk in asymptomatic patients.J Am Coll Cardiol. 2010; 55: 1169-1177
- Rosuvastatin in older patients with systolic heart failure.N Engl J Med. 2007; 357: 2248-2261
- Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial.Lancet. 2008; 372: 1231-1239
- Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis.N Engl J Med. 2005; 353: 238-248
- Rosuvastatin and cardiovascular events in patients undergoing hemodialysis.N Engl J Med. 2009; 360: 1395-1407
- The JUPITER and AURORA clinical trials for rosuvastatin in special primary prevention populations: perspectives, outcomes, and consequences.Vasc Health Risk Manag. 2009; 5: 1033-1042
- Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the Aortic Stenosis Progression Observation: Measuring Effects of Rosuvastatin (ASTRONOMER) trial.Circulation. 2010; 121: 306-314
- Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.N Engl J Med. 2008; 359: 2195-2207
- Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials.Circulation. 2010; 121: 1069-1077
- Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds risk score.JAMA. 2007; 297: 611-619
- C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds risk score for men.Circulation. 2008; 118: 2243-2251
- Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA study): a prospective randomised controlled trial.Lancet. 2006; 368: 1155-1163
- Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation.J Am Coll Cardiol. 2008; 51: 1512-1524
- Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women.JAMA. 2005; 294: 326-333
- Clinical implications of inflammation for cardiovascular primary prevention.Eur Heart J. 2010; 31: 777-783
Article Info
Publication History
Accepted:
May 26,
2010
Received in revised form:
May 26,
2010
Received:
April 23,
2010
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
