A proposal to incorporate trial data into a hybrid ACC/AHA algorithm for the allocation of statin therapy in primary prevention

Journal of the American College of Cardiology
Paul M RidkerNancy R Cook

Abstract

Current algorithms for statin allocation in primary prevention use epidemiologic estimates of absolute risk. However, a global risk prediction score has not been used as an enrollment criterion in any randomized trial of statin therapy. Moreover, completed statin trials show greater relative risk reductions for those patients at lower levels of absolute risk. Thus, risk calculators that rely solely on epidemiologic modeling do not ensure that those who will benefit are selected for treatment. We propose a hybrid approach to statin prescription for apparently healthy men and women that strongly endorses pharmacologic treatment for those who have estimated 10-year risks ≥7.5% and for whom trial-based evidence supports statin efficacy in primary prevention. Although individuals could still be treated on the basis of absolute risk alone, the hybrid approach is evidence-based, is easily applied in clinical practice, and may increase the transparency of physician-patient interactions concerning prescription of statin therapy in primary prevention.

References

Jul 22, 2005·The New England Journal of Medicine·Christoph WannerUNKNOWN German Diabetes and Dialysis Study Investigators
Jan 5, 2008·International Journal of Clinical Practice·G Jackson
Nov 11, 2008·The New England Journal of Medicine·Paul M RidkerUNKNOWN JUPITER Study Group
Apr 1, 2009·The New England Journal of Medicine·Bengt C FellströmUNKNOWN AURORA Study Group
Feb 20, 2010·Lancet·Christopher P Cannon
Oct 5, 2011·BMJ : British Medical Journal·Johannes A N DorresteijnNancy R Cook
Jul 20, 2012·Circulation. Cardiovascular Quality and Outcomes·Paul M Ridker
Aug 15, 2013·JAMA : the Journal of the American Medical Association·Paul M Ridker, Peter W F Wilson
Nov 26, 2013·Lancet·Paul M Ridker, Nancy R Cook
Feb 12, 2014·European Heart Journal·Joep van der LeeuwFrank L J Visseren

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Citations

Dec 25, 2015·Journal of the American College of Cardiology·Vera Bittner
Dec 25, 2015·Journal of the American College of Cardiology·Martin B MortensenErling Falk
Oct 8, 2016·Journal of the American College of Cardiology·Ashley PenderPhilip Greenland
Feb 6, 2017·Journal of the American College of Cardiology·Kwang Kon Koh

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