TY - JOUR
T1 - Using age- and sex-specific risk thresholds to guide statin therapy
T2 - One size may not fit all
AU - Navar-Boggan, Ann Marie
AU - Peterson, Eric D.
AU - D'Agostino, Ralph B.
AU - Pencina, Michael J.
AU - Sniderman, Allan D.
N1 - Funding Information:
This study was supported by unrestricted grants from the Doggone Foundation and with research funds from the Duke Clinical Research Institute . The Framingham Heart Study is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with Boston University (contract N01-HC-25195). This article has been reviewed by Framingham Heart Study investigators for scientific content and consistency of data interpretation with previous Framingham Heart Study publications. Dr. Peterson has received funding for research grants from Eli Lilly and Janssen Pharmaceuticals ; and funding for serving as a consultant/participant on advisory boards for Merck, Sanofi, Janssen Pharmaceuticals, and Boehringer Ingelheim. Dr. Pencina has received funding for serving as a consultant for AbbVie. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2015 by the American College of Cardiology Foundation.
PY - 2015/4/28
Y1 - 2015/4/28
N2 - Abstract Background New cholesterol guidelines emphasize 10-year risk of cardiovascular disease (CVD) to identify adults eligible for statin therapy as primary prevention. Whether these CVD risk thresholds should be individualized by age and sex has not been explored. Objectives This study evaluated the potential impact of incorporating age- and sex-specific CVD risk thresholds into current cholesterol guidelines. Methods Using data from the Framingham Offspring Study, this study assessed current treatment recommendations among age- and sex-specific groups in 3,685 participants free of CVD. Then, it evaluated how varying age- and sex-specific 10-year CVD risk thresholds for statin treatment affect the sensitivity and specificity for incident 10-year CVD events. Results Basing statin therapy recommendations on a 10-year fixed risk threshold of 7.5% results in lower statin consideration among women than men (63% vs. 33%; p < 0.0001), yet most of the study participants who were 66 to 75 years of age were recommended for statin treatment (90.3%). The fixed 7.5% threshold had relatively low sensitivity for capturing 10-year events in younger women and men (40 to 55 years of age). Sensitivity of the recommendations was substantially improved when the treatment threshold was reduced to 5% in participants who were 40 to 55 years of age. Among older adults (66 to 75 years of age), specificity was poor, but when the treatment threshold was raised to 10% in women and 15% in men, specificity significantly improved, with minimal loss in sensitivity. Conclusions Cholesterol treatment recommendations could be improved by using individualized age- and sex-specific CVD risk thresholds.
AB - Abstract Background New cholesterol guidelines emphasize 10-year risk of cardiovascular disease (CVD) to identify adults eligible for statin therapy as primary prevention. Whether these CVD risk thresholds should be individualized by age and sex has not been explored. Objectives This study evaluated the potential impact of incorporating age- and sex-specific CVD risk thresholds into current cholesterol guidelines. Methods Using data from the Framingham Offspring Study, this study assessed current treatment recommendations among age- and sex-specific groups in 3,685 participants free of CVD. Then, it evaluated how varying age- and sex-specific 10-year CVD risk thresholds for statin treatment affect the sensitivity and specificity for incident 10-year CVD events. Results Basing statin therapy recommendations on a 10-year fixed risk threshold of 7.5% results in lower statin consideration among women than men (63% vs. 33%; p < 0.0001), yet most of the study participants who were 66 to 75 years of age were recommended for statin treatment (90.3%). The fixed 7.5% threshold had relatively low sensitivity for capturing 10-year events in younger women and men (40 to 55 years of age). Sensitivity of the recommendations was substantially improved when the treatment threshold was reduced to 5% in participants who were 40 to 55 years of age. Among older adults (66 to 75 years of age), specificity was poor, but when the treatment threshold was raised to 10% in women and 15% in men, specificity significantly improved, with minimal loss in sensitivity. Conclusions Cholesterol treatment recommendations could be improved by using individualized age- and sex-specific CVD risk thresholds.
KW - cardiovascular disease
KW - cholesterol treatment
KW - sensitivity
KW - specificity
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U2 - 10.1016/j.jacc.2015.02.025
DO - 10.1016/j.jacc.2015.02.025
M3 - Article
C2 - 25743624
AN - SCOPUS:84928017267
VL - 65
SP - 1633
EP - 1639
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 16
M1 - 21014
ER -